CentraCare
In the critically ill population, fluid administration in an unstable patient is perhaps the most common intervention that is performed. Uncorrected hypovolemia with inappropriate vasopressors lead to organ hypoperfusion where as overzealous fluid administration especially in ARDS (Adult respiratory distress syndrome) can increase mortality. It has been estimated that only 50% of hemodynamically unstable critically ill patients are volume responsive, hence dynamic assessment of preload responsiveness has been proposed to better identify those individuals who would benefit from fluid bolus.
Fluid responsiveness in patients with moderate to severe ARDS is crucial, as additional unnecessary fluid may be harmful. Various techniques of hemodynamic assessment exist, each with its own advantages and limitations. This study compares different techniques of preload responsiveness that include passive leg raise (PLR) and mini-fluid challenge induced changes in Pulse pressure variation (PPV), End tidal CO2, Bioreactance based Stroke volume index (SVI) and velocity time integral (VTI) on Echocardiogram. Study protocol : Baseline Echo with VTI will be obtained Bed side monitor will be set…
Inclusion Criteria: * Age between 30 - 90 years * Diagnosis of Vasodilatory Shock with no other obvious cause of hypotension * Diagnosis of ARDS with PF ratio \< 150 , PEEP \> 8 * Patients who are under paralysis or deeply sedated, on a mechanical ventilator Exclusion Criteria: * Patients with arrhythmias including atrial fibrillation * Patients with chest tube, intra-abdominal hypertension or with its risk factors * Patients with structural heart disease including pulmonary hypertension (RVSP \> 45) and heart failure * Patients on extracorporeal support such as ECMO, CRRT or MCS. * Patient…
No interventions other than fluid challenge
Arctuva estimate
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