Septic Shock Clinical Trial
Official title:
Evaluation of New Hemodynamic Indices to Predict Response to Volemic Expansion in Septic Shock
The objective is to determine the sensitivity and specificity via Receiver Operating Characteristic (ROC) curve of Global Longitudinal Strain (GLS) The secondary objectives are the same for the change in the amount of carbon dioxide exhaled (ΔEtCO2) and dynamic arterial elastance (Eadyn). it will also determine the sensitivity and specificity of these indices, either individually or combined to determine persistent responders to volemic expansion.
The best practice recommendations are to evaluate the preload dependence before performing a
vascular filling test. This evaluation is based on the analysis of dynamic hemodynamic
indices such as the variation of pulsed pressure (VPP), the variation of the volume of
ejection (VVE) or the variation of the cardiac output during the realization of a test of
rising of passive leg (ELJP). However, these indices require strict validation conditions.
New hemodynamic indices have appeared recently and appear promising in the evaluation of
preload dependence. Among them, the analysis of longitudinal myocardial deformity by speckle
tracking (GLS) and its variation during an ELJP (ΔGLS). The analysis of changes in the amount
of CO2 exhaled (ΔEtCO2) reflects cardiac output in ventilated patients or the analysis of
dynamic arterial elastance (Eadyn) calculated by comparing the VPP and the EVV which is a
reflection of the coupling between the left ventricle and the arterial network.
In this work the assumption that the analysis of Δ GLS, ΔEtCO2 and Eadyn can predict the
response to volume expansion in the ventilated patient, in septic shock under vasopressor.
The investigators include at least 51 patients, ventilated, under vasopressors with septic
shock. GLS, cardiac output, VVP, VVE, blood pressure, Eadyn, EtCO2 will be measured before
and after ELJP. In the event of an increase of more than 10% in cardiac output during the
ELJP, patients will receive a volume expansion of 500ml of balanced crystalloids. The same
measurements will be repeated immediately at the end of the volume expansion and 20 minutes
after the end of the infusion. Patients with a 15% increase in cardiac output at the end of
volume expansion will be classified as responders. Patients with a 15% increase in cardiac
output 20minutes after the end of volume expansion will be classified as persistent
responders.
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