Circulatory Failure Clinical Trial
Official title:
Effect of Volume EXpansion witH ALbumin vs. Crystalloid on EIT-derived Expiratory Lung Impedance in Critically Ill, Hemodynamically Unstable Patients. A Single-blind, Randomized and Controlled Study
Acute circulatory failure reduces oxygen delivery below cellular requirements, potentially
leading to organ failure. Intravenous fluids are generally administered with the aim of
increasing cardiac output and restore organ perfusion. Nevertheless, only 50% of patients
increase their cardiac output, while in the remainder not only does fluid loading provide no
benefit but it also leads to volume overload (peripheral and pulmonary edema).
There are two types of resuscitation fluids, colloids and crystalloids. Given their oncotic
pressure, colloids should remain in the intravascular space, while crystalloids distribute
into the whole extracellular compartment, potentially increasing the risk of tissue edema.
Surprisingly, only few studies directly compared albumin and crystalloids in terms of their
overload-related side effects.
Electrical impedance tomography (EIT) is a noninvasive, radiation-free, lung imaging
modality, which shows lung impedance as determined by small electrical currents. An increase
in intrapulmonary gas volume increases impedance, while an increase in blood or fluid volume,
lowers it. EIT has a high temporal resolution, allowing to assess ventilation and perfusion
in real-time. Preliminary data suggest its value to assess the variations of intrathoracic
fluid in patients with pulmonary edema.
The aim of the present single-blind, randomized, controlled study is to compare the effect of
a fluid challenge with albumin vs. crystalloids on EIT-derived lung impedance in a group of
56 critically ill patients with acute circulatory failure. Our hypothesis is that fluid
challenge with albumin leads to a lesser decrease in lung impedance, that is a lesser
extravasation of fluids into the lungs.
Hemodynamic and respiratory variables, blood samples, cardiac ultrasound and EIT measurements
will be recorded before the fluid challenge, and repeated at the end of fluid infusion, 20
and 60 minutes after. Factorial Analysis of variance for repeated measures will be used to
assess the effects of fluid loading
n/a
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