Shock Clinical Trial
— PICC-ECHOOfficial title:
Concordance Study of Therapeutic Decision-making in Patients With Acute Circulatory Failure Between Cardiac Output Monitoring by Transthoracic Echocardiography and by Transpulmonary Thermodilution : PICC-ECHO Study
Shock is a serious complication corresponding to acute circulatory failure resulting in multiorgan failure and death. In order to improve cellular oxygen utilization, several therapies can be used. To select one of them, the monitoring of cardiac output is helpful. However, there are several methods used in current practice in intensive care for evaluating hemodynamic. Currently, in patients with acute circulatory failure, no study has compared the concordance of therapeutic decision-making based on transpulmonary thermodilution or transthoracic echocardiography. The objective of the PICC-ECHO study is thus to assess the concordance of therapeutic decision-making by several experts, based on data from transpulmonary thermodilution or transthoracic echocardiography. Indeed, the investigators hypothesize that performing hemodynamic monitoring based on transpulmonary thermodilution or transthoracic echocardiography does not lead to the same therapeutic management in patients in shock.
Status | Recruiting |
Enrollment | 15 |
Est. completion date | January 2025 |
Est. primary completion date | December 2024 |
Accepts healthy volunteers | No |
Gender | All |
Age group | 18 Years and older |
Eligibility | Inclusion Criteria: - adult patient, hospitalized in the Intensive Care Medicine, CHU of Angers; - patient requiring a hemodynamic evaluation because of an acute circulatory insufficiency defined by : arterial hypotension requiring vasopressor amines, with clinical signs (mottling, encephalopathy, oliguria > 2h) and/or biological signs (pH <7.38; lactate > 2 mmol/L) of tissue hypoperfusion; - patient monitored by transpulmonary thermodilution with pulse wave contour measurement (PiCCO) as part of routine care. Exclusion Criteria: - patient with acute pulmonary heart on TTE (defined as a LV-to-VG ratio > 0.6 associated with a paradoxical interventricular septum); - patient objecting to participation in the research; - a relative who has received the information, if the patient's condition does not allow it, and who objects to the participation of his or her relative in the research; - persons protected by law. |
Country | Name | City | State |
---|---|---|---|
France | CHU Angers | Angers |
Lead Sponsor | Collaborator |
---|---|
University Hospital, Angers |
France,
Type | Measure | Description | Time frame | Safety issue |
---|---|---|---|---|
Primary | Intra-expert concordance of therapeutic management according to PICCO device or echocardiography monitoring. | the concordance of hypothetical therapeutic decision-making done a posteriori by experts in patients with acute circulatory failure between cardiac output monitoring by transthoracic echocardiography or by transpulmonary thermodilution. | at inclusion | |
Secondary | Inter-expert concordance of therapeutic management according to PICCO device or echocardiography monitoring. | the inter-expert concordance of therapeutic management according to data from transpulmonary thermodilution or transthoracic echocardiography. | at inclusion | |
Secondary | Intra and inter expert concordance of therapeutic management according to PICCO device or without advance cardiac output monitoring. | the intra-expert and inter-expert concordance of theoretical therapeutic management according to data provided by PICCO device or without cardiac output monitoring | at inclusion | |
Secondary | History and clinical situation | the difference in history and clinical situation in patients for whom theoretical therapeutic management is discordant or not according to the different methods: PICCO device vs echocardiography; PICCO vs no hemodynamic monitoring; echocardiography vs no hemodynamic monitoring | at inclusion | |
Secondary | Decision of volume expansion | the intra-expert and inter-expert concordance of the decision of volume expansion according to data from the different methods: PICCO vs echocardiography, PICCO vs no hemodynamic monitoring, echocardiography vs no hemodynamic monitoring | at inclusion | |
Secondary | frequency of volume expansion, change in norepinephrine and dobutamine according to the method of cardiac output monitoring. | the frequency of use of volume expansion, vasopressor support and inotropic support (dobutamine) according to the method of cardiac output monitoring: PICCO vs echocardiography, PICCO vs no hemodynamic monitoring, echocardiography vs no hemodynamic monitoring | at inclusion | |
Secondary | the description of the expert population | Description of the expert population (seniority in the intensive care unit, place of practice : hospital or university hospital, number of beds in the intensive care unit in which the expert works, which haemodynamic monitoring tool is used in current practice by the expert. | at inclusion | |
Secondary | the concordance between experts and clinician management | Concordance of decision between expert and clinician management | at inclusion |
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