The MostCare system, thanks to the Pressure Recording Analytical Method (PRAM; Vygon, Padua, Italy), provides new hemodynamic parameters of the cardiovascular system. The PRAM method is a noncalibrated pulse contour method which requires only an arterial line (radial or femoral). This method has been validated in various clinical conditions. Among the collected parameters, some are well known and used daily care in Intensive Care Unit (ICU), i.e. cardiac output (CO), arterial pressure, heart rate, stroke volume (SV). Others such as arterial elastance (Ea) or dicrotic pressure are more recent and merit further investigation to determine their interest in clinical practice. To date, it is rarely used to adapt therapies, mostly because of a lack of knowledge regarding the evolution of these parameters. The aim of this study is to analyze the relationship between the evolution of Arterial Elastance and fluid responsiveness after a 250 mL fluid challenge of crystalloids in 5 minutes in patients with either septic shock or in the postoperative course of a major vascular surgery. Patients will be considered fluid responders if an increase \>10% of the stroke volume is observed .
Study Type
OBSERVATIONAL
Enrollment
80
All patients who met the inclusion criteria will receive a standardised bolus of 250 ml of crystalloid in 5 minutes administered by hand with a 50 ml syringe. During the study period, hemodynamic parameters and analysis by pressure recording analytical method obtained with the MostCare will be collected for 20 minutes prior to the intervention (fluid challenge), during the fluid challenge and 25 minutes after completion. The total duration of the intervention (fluid loading) is 5 min. The total duration of hemodynamic parameters recording is 60 min.
CHRU
Nancy, France
RECRUITINGEvolution of arterial elastance
Absolute and percentage of change in arterial elastance during the study period
Time frame: 60 minutes
Evolution of Stroke Volume (SV)
Absolute and percentage of change in stroke volume during the study period
Time frame: 60 minutes
Evolution of Dicrotic Pressure (DP) value during a fluid challenge
Absolute and percentage of change in dicrotic pressure during the study period
Time frame: 60 minutes
Predictive factors of an increase or a decrease in the arterial elastance value
Identification of clinical or arterial pressure waveform parameters associated with an increase or a decrease of the arterial elastance * epidemiological and clinical: age, BMI, gender, SAPS II, SOFA, Charlson comorbidity index, chronic diseases, etiology of the septic shock, acute kidney injury * therapeutical: chronic treatments, vasoactive and sedative drugs, epidural analgesia, mechanical ventilation (VT, RR, PEEP) * surgery: type of surgery (open or endovascular), indication, timing. * indication for fluid loading: hypotension, oliguria, hyperlactatemia \> 2mmol/L, mottling
Time frame: 60 minutes
Predictive factors of an increase or a decrease of the dicrotic pressure value
Identification of clinical or arterial pressure waveform parameters associated with an increase or a decrease of the dicrotic pressure
Time frame: 60 minutes
Evolution of norepinephrine dose: before and 60 minutes after fluid challenge
Norepinephrine dose expressed in micrograms per kilogram per minute (μg/kg/min)
Time frame: 60 minutes
All-cause mortality
30 days all-cause mortality
Time frame: 30 days
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