Discontinuous Echocardiographic Subcostal Cardiac Output Measurement

Официальное название

Discontinuous Echocardiographic Subcostal Cardiac Output Measurement by the Right Ventricular Outflow Tract in Critical Care

Обзор

Cardiac output (CO) monitoring is recommended for the most serious and multiple-failure patients in critical care and allows the diagnosis of acute circulatory failure as well as its etiology and also allows the monitoring of treatments. However, although allowing an adaptation of hemodynamic treatments and being integrated into a therapeutic personalization approach in situations of acute circulatory failure, the measurement of CO is conditioned by the availability of devices, by their sometimes problematic invasiveness, as well as their cost. In addition, the discontinuous measurement of CO by echocardiography is made difficult in the context of resuscitation with patients who are less mobilizable and less echogenic.

Подробное описание

The subcostal assessment route is the classic emergency route. It allows for the analysis of the basic segmental kinetics of the left ventricle, an analysis of the Left Ventricular Ejection Fraction (LVEF), the search for pericardial effusion or even tamponade, or the search for right ventricular dilation. A measurement of CO via the right ventricular outflow tract using transthoracic echocardiography has never been described in the literature, although it is feasible, based on the same mathematical rationale as the standard measurement of cardiac output via the left ventricular outflow tract (which takes into account the diameter of the outflow tract and the subvalvular time-velocity integral \[TVI\]).

Since at all times the left (systemic) CO is equal to the right (venous return) CO, it is therefore possible to consider a measurement of CO via the subcostal route. By not complicating the standard care of patients in critical care, especially in situations of acute circulatory failure, and by adding only a few seconds or even minutes to an examination already recommended and routine in critical care, this evaluation approach seems interesting given the need and the recommendations in force on the monitoring of patients in intensive care and more particularly of DC.

Вмешательства

• Другое Discontinuous subcostal echocardiographic cardiac output assessment
  Right Ventricular Outflow Chamber Diameter (RVOD) and Left Ventricular Outflow Chamber Diameter (LVOD) assessments via subcostal approach

Первичные конечные точки

• Measurement of Cardiac Output (CO) via the subcostal route [Срок оценки: At Enrollment visit and DAY 28]

Вторичные конечные точки (3)

• Compare the measurement success rate of DC-CEVD to that of DC-CEVG. [Срок оценки: At Enrollment visit and DAY 28]
• To assess the concordance of DC variation during preload-dependence search maneuvers (passive leg raise) in intubated and ventilated patients between DC-CEVD and DC-CEVG measurements. [Срок оценки: At Enrollment visit and DAY 28]
• DC measurement by transpulmonary thermodilution device [Срок оценки: At Enrollment visit and DAY 28]

Критерии участия

Критерии включения

• Adult patient (Age ≥ 18 years)
• Patient admitted to the intensive care unit at Rouen University Hospital.
• Transthoracic echocardiography (TTE) is required upon admission or during the patient's stay for diagnostic assessment and/or therapeutic monitoring.

Критерии исключения

• Person deprived of liberty by an administrative or judicial decision or person placed under judicial protection/guardianship or curatorship
• Patient not affiliated with the social security system
• Refusal by the patient or trusted person if the patient is incapable of expressing consent
• Pregnant woman
• Dying patient

Критерии приведены из реестра в оригинале (на английском). Окончательную оценку соответствия проводит исследовательский центр.

Здоровые добровольцы: Нет

Дизайн исследования

Модель наблюдения

Только случаи

Центры проведения

Франция · 1 центр

• University Rouen Hospital — Rouen

Идентификаторы

NCT: NCT07177391 · 2024/0200/OB · 2024-A01706-41

Первоисточники (государственные реестры)

• ClinicalTrials.gov (NIH, США)

Открыть это исследование на ClinicalTrials.gov ↗