RecruitingNCT05225402

Hemodynamic Measurements of Macrocirculatory and Perfusion Parameters in ICU

Effects of Norepinephrine on Hemodynamic Measurements of Macrocirculatory and Perfusion Parameters in ICU Patients with Septic Shock

Sponsor

Copenhagen University Hospital, Hvidovre

Enrollment

45 participants

Start Date

Mar 8, 2022

Study Type

OBSERVATIONAL

Conditions

Septic Shock Hemodynamic Instability Vasoconstriction

Summary

In septic shock there is growing evidence of a state of hemodynamic "disconnection" with seemingly adequate macrocirculatory values despite actual microcirculation failing to meet cellular demand. Norepinephrine (NE) is recommended as first choice vasoactive agent for the treatment of septic shock. However, the dynamic effects of NE on macro- and microcirculation and perfusion parameters has not been described in detail in the context of septic shock, precluding rational individualized titration of NE and fluids, as recommended recently. In the present prospective observational multicenter study in adult septic shock patients, we intend to explore the effects of NE on preload dependency and tissue perfusion by evaluating the correlation and potential discrepancies between macro- and microcirculation both during titration of NE and after fluid resuscitation. The conclusions drawn from our study will contribute to the physiological knowledge necessary for establishing individualized evidence-based bedside management of hemodynamics in the setting of septic shock.

Eligibility

Min Age: 18 Years

Inclusion Criteria4

Suspected or documented infection
Need for vasopressors to maintain mean arterial blood pressure (MAP) ≥65 mmHg
Serum lactate levels \>2 mmol/L
Norepinephrine infusion of \> 0.2 mcg/kg/min

Exclusion Criteria4

Absolute contraindication for esophageal doppler or urinary catheter insertion as noted in the patients' charts.
Severe valvular pathology and cardiac arrhythmias resulting in severe hemodynamic instability.
Lithium treatment
Treatment with other vasopressor or inotropic drugs.

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Interventions

DRUGHemodynamic measurements during reduction in Norepinephrine and fluid boli.

1. Extended monitoring equipment will be connected to the patient. Clinical and biochemical parameters will be collected for a baseline before the next step. A Safety check will be performed to ensure correct patient data, correct equipment function and safety measures are meet. A passive leg raise test will be performed to predict fluid responsiveness, in case of a positive test, a fluid challenge will be administered. 2. A stepwise reduction of the NE infusion rate from baseline while monitoring stroke volume (SV) to elucidate changes in SV and potential preloadresponsiveness. The reduction will occur in steps of 3-5 minute until either discontinuation of the norepinephrine infusion, a 50% reduction in SV or MAP\<40. 3. While maintaining the NE infusion rate from the previous step 2, a fluid challenge will be administrated, until additional fluid does not increase SV\>10%. 4. As in step 2, a stepwise increase in NE infusion rate to the baseline infusion level or the baseline BP.