RApid Fluid Volume EXpansion in Patients in Shock After the Initial Phase of Resuscitation.
Status:
Recruiting
Trial end date:
2021-12-16
Target enrollment:
Participant gender:
Summary
Rapid volume expansion using repeated intravenous fluid boluses is a very common intervention
performed in the intensive care unit (ICU) in the early days of resuscitation of patients
with shock. Once passed the initial phase of resuscitation, the fluid boluses administered
fail to effectively increase the patients' cardiac output in about 50% of cases. Pulse
pressure changes or stroke volume changes induced by a Passive Leg Raising (PLR) test have
acceptable/good ability to predict fluid responsiveness (in terms of cardiac output change)
and may be systematically used in patients with persistent shock with the aim of limiting the
total amount of fluid administered to patients by avoiding undue fluid boluses. One may
suppose that such a volume expansion management policy could impact morbidity and mortality
of shocked patients. Among the predictive indices available in clinical practice, the PLR
test has the advantages of being usable regardless of the patients' respiratory status and
cardiac rhythm. Changes in left ventricular stroke volume during the PLR test perform better
that changes in pulse pressure to predict fluid responsiveness. However, in counterpart,
pulse pressure changes during PLR can be assessed without the need of other hemodynamic
exploration such central venous pressure measurement or cardiac output monitoring. The
investigators hypothesized that strategies using either stroke volume changes or pulse
pressure changes induced by the PLR test to decide wether a fluid bolus clinically deemed
indicated should or should not be administered, may limit the amount of fluid received by the
patients during the first 5 days of shock, improve their oxygenation index, and shorten the
time passed under mechanical ventilation, as compared to a "liberal" strategy (usual care)
that does not use predictive indices of fluid responsiveness.