Diagnostic Performance of the Mitral Annulus Velocity Variation Measured by Tissue Doppler to Evaluate the Fluid Responsiveness During the Initial Management of Shock in Patients Admitted to the Emergency Department
Centre Hospitalier Universitaire de Nīmes
187 participants
Aug 1, 2023
OBSERVATIONAL
Conditions
Summary
Assessing the response to vascular filling in shock is a challenge in emergency medicine. The mitral annulus velocity measured by tissue Doppler (E') has recently been characterized as sensitive to the preload conditions of a patient. The investigators hypothesize that the E' variation (∆E') before and after fluid filling allows us to assess the response to vascular filling. The investigators hypothesize that the ∆E' has a good diagnostic performance to establish whether a patient is responsive to fluid filling, defined by an area under the ROC curve greater than 0.75.
Eligibility
Inclusion Criteria6
- Patient has been informed of the study and does not refuse to participate.
- Patient is at least ≥ 18 years of age.
- The patient must be beneficiary of a health insurance plan.
- Patient has shock with a mean blood pressure less than 65 mmHg (\<)
- The patient does not have acute intracranial pathology
- The referring physician has decided on a vascular filling with 500mL of crystalloids (NaCl 0.9% or Ringer lactate)
Exclusion Criteria6
- The patient has already received 2 vascular fillings since the beginning of his management
- The patient is in shock and has a contraindication to vascular filling : shock of a cardiogenic or obstructive nature
- The patient has an intracranial pathology requiring maintain a MAP ≥ 80 mmHg
- The patient is intubated or on Non-Invasive Ventilation before the vascular filling
- The patient is under court protection
- The patient is pregnant, parturient or nursing
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Interventions
During the inclusion visit, the patient will receive 3 cardiac ultrasonography. The first one will be performed at the time of the initiation of the 500mL vascular filling (T0), without delaying and the second one after the end of the filling (Tfin). These first two ultrasound are part of standard practice. A third will be performed 20 minutes after the end of the vascular filling (Tfin+20).
Locations(1)
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NCT05888974