O2 Consumption And CO2 Production After Hemodynamic Optimization In Shock

Fondazione Policlinico Universitario Agostino Gemelli IRCCS36 enrolled

Overview

The goal of this prospective observational study is to analyse change in VO2 and VCO2 measured via a dedicated ventilator after hemodynamic optimization maneuvers in adult patients admitted to the ICU with any sign of shock. The main questions it aims to answer are: 1. Do common maneuvers for hemodynamic optimization (fluid bolus and/or vasopressor administration) have any impact on tissue perfusion in terms of oxygen consumption (VO2) and carbon dioxide production (VCO2) measured by a dedicated ventilator? 2. Are the values measured by exhaled gas comparable to those calculated by the measurement of dissolved veno-arterial gas? Participants enrolled in the study will receive advanced hemodynamic monitoring with MostCare Up (Vygon ®) and their hemodynamic instability will be managed according to most recent guidelines and based on clinical decision of treating physicians.

Study Type

OBSERVATIONAL

Enrollment

Conditions

Hemodynamic Instability Oxygen Consumption (V̇O2)

Interventions

Noradrenalin

After inclusion, patients will be tested for fluid responsiveness. Pulse pressure variation (PPV) will be evaluated. In case of PPV\> 13% a fluid bolus of 500 mL of Lactated Ringer's will be administered in 10 minutes. If PPV\< 8% Norepinephrine will be administered or increased. If PPV is in the gray zone, a PLRT will be performed and if CO increases more than 10% a fluid bolus will be prescribed, otherwise norepinephrine increased.

Fluid bolusOTHER

Eligibility

Sex: ALLMin age: 18 Years

Medical Language ↔ Plain English

Inclusion Criteria: Hypotension (MAP\< 65mmHg or sudden drop in MAP \> 15 mmHg) and one of the following conditions: * Heart rate \> 120 bpm * Urinary output \< 0.5 ml/kg/h for at least two hours * Lactate \> 2 mmol/L Exclusion Criteria: * Urgent need for surgery * Urgent need for veno-arterial ECMO or severe hemodynamic instability * Consistent risk of imminent death * Severe ARDS or severe respiratory failure (p/F \< 100 mmHg) and/or FiO2\>0.8 * Severe heart failure (NYHA 4 and/or EF\<25%) * Need for intermittent or continuous renal replacement therapy (IRRT or CRRT) * Anemia defined as Hb\<8 g/dL * VO2 variability \< 5% throughout ten minutes of stabilization before procedure start * Intraabdominal hypertension, defined as intraabdominal pressure \> 18 mmHg * Pregnancy * Withdrawal or refuse of informed consent * Terminal disease * Do-not-resuscitate order.

Outcomes

Primary Outcomes

Change in VO2

Change in VO2, measured via a dedicated ventilator after either fluid expansion or increase in vasopressors administration.

Time frame: Two minutes after the end of fluid bolus infusion or vasopressor increase, and every 10 minutes for one hour

Secondary Outcomes

Change in VCO2

Change in VCO2, measured via a dedicated ventilator after either fluid expansion or increase in vasopressors administration.