Evaluation of Fluid Resuscitation in Shocked Patients by Electrical Cardiometry in Comparison to Transthoracic Echocardiography.

Al-Azhar University50 enrolled

Overview

The aim of this study is to evaluate the diagnostic accuracy of electrical cardiometry (EC) for the noninvasive determination of fluid responsiveness in critically ill shocked patients and agreement of EC compared to transthoracic echocardiography (TTE)

Electrical cardiometry (EC), based on thoracic electrical bioimpedance, can measure SV continuously and non-invasively. The EC"s working principle of estimation of SV is to utilize changes in thoracic electrical impedance, which is mainly influenced by erythrocyte orientation and peak flow velocity in the ascending aorta throughout the cardiac cycle. Electrical cardiometry (EC) has been validated to monitor SV and other hemodynamic parameters non-invasively compared to different techniques such as thermodilution technique, transesophageal Doppler echocardiography and cardiac catheterization including critically ill patients, intra-operative settings, in pregnant women, in children with congenital heart diseases, even in obese children

Study Type

OBSERVATIONAL

Enrollment

Conditions

Fluid Resuscitation Electrical Cardiometry Transthoracic Echocardiography Shock

Interventions

Assessment of fluid responsiveness by electrical cardiometryDEVICE

Electrical cardiometry (EC) measurements: by the ICON\_ hemodynamic monitor (ICON Cardiotropic, Inc., La Jolla, CA 92307; Osyka Medical GmbH, Berlin, and Germany, model C3). Transthoracic echocardiography (TTE) measurements will be performed equipped with echo probe. SV of the left ventricle will be calculated using LVOT diameter (D) just below the aortic valve from parasternal long-axis view and VTI measured in LVOT from apical 5 chamber view (by pulsed wave Doppler).

Eligibility

Sex: ALLMin age: 25 YearsMax age: 65 Years

Medical Language ↔ Plain English

Inclusion Criteria: * Age from 25 to 65 years old. * Both sexes. * Patients with clinical criteria of shock \[mean arterial pressure (MAP) ≤ 65 mmHg and tissue hypoperfusion (ScvO2 \<70%, P(cv-a) CO2 ≥6 mmHg, CRT ≥4 s and lactate \>2mmol/l). Exclusion Criteria: * Refusal to sign the consent by a first degree relative. * Previous cardiac disease, rhythm other than sinus rhythm or heart rate \> 140 beat/min. * Renal failure (acute or chronic).

Locations (1)

Al-Azhar University

Cairo, Egypt

Outcomes

Primary Outcomes

Diagnostic accuracy of Electrical cardiometry (EC) to predict fluid responsiveness

Electrical cardiometry will be done be done immediately before fluid resuscitation and every 30 min till mean arterial pressure (MAP) \> 65 mmHg

Time frame: Intraoperative and every 30 minutes till MAP>65mmHg

Secondary Outcomes

Agreement of Electrical cardiometry(EC) with Transthoracic echocardiography (TTE) in the change of stroke volume before and after fluid challenge

Fluid resuscitation will be done by intravenous infusion of lactated ringer guided by fluid responsiveness (fluid responder if SV increases by \> 10% after the fluid challenge. If the patient becomes fluid non-responder, vasopressor infusion or inotrope will start. The end of the study is when mean arterial pressure (MAP) \> 65 mmHg (either by fluid or both fluid and vasopressor).

Time frame: Intraoperatively.

Data from ClinicalTrials.gov

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