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The aim of the study is to identify the diagnostic value of the focused assessed echocardiography in septic patients undergoing urgent abdominal surgery due to peritonitis. The investigators expect that the incidence of hemodynamic instability will be reduced and the survival of the patients will be improved.
Often sepsis remains undiagnosed at the very beginning because of the concentration to the surgical pathology in perioperative period. This results in unacceptably high mortality. The investigators hypothesize that extended hemodynamic monitoring by focused transthoracic echocardiography will personalize early fluid resuscitation which will improve patient's outcome.
The goals of the investigators study are:
The investigators hypothesize that focused echocardiography monitoring will result in more administrated intravenous fluids during perioperative period.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Non-echo group | No Intervention | Patients get the standard monitoring and treatment based on Good medical practice. Extended monitoring by focused echocardiography is not applied for this group. | |
| Focussed echocardiography group | Experimental | The extended cardiac monitoring by focused assessed transthoracic echocardiography is applied. |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Focused assessed echocardiography | Other | Focused assessed transthoracic echocardiography is non-invasive, painless procedure. The transducer is placed on the chest at certain locations and angles to get the required information on patient's condition. |
| Measure | Description | Time Frame |
|---|---|---|
| Inpatient mortality in both treatment arms. | Comparison of 30 days intra-hospital mortality in both arms. | 30 days intra-hospital mortality |
| Measure | Description | Time Frame |
|---|---|---|
| Comparison of incidence of severe hypotension MAP <65 mmHg after anaesthesia induction in both arms. | To evaluate the incidence of severe hypotension after anesthesia induction (1 - 5 minutes after induction) in both groups. | 1-5 minutes after anaesthesia induction. |
| Comparison of fluid management in both arms (from hospitalisation to the surgery, during the surgery, after the surgery up to 24 hours). |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Andrius Macas, profesor | Lithuanian university of health sciencies | Study Chair |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Lithuanian university of health sciencies | Kaunas | A. Mickeviciaus Street 9 | LT-44307 | Lithuania |
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| ID | Term |
|---|---|
| D018805 | Sepsis |
| D020896 | Hypovolemia |
| D010538 | Peritonitis |
| ID | Term |
|---|---|
| D007239 | Infections |
| D018746 | Systemic Inflammatory Response Syndrome |
| D007249 | Inflammation |
| D010335 | Pathologic Processes |
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Comparison of tow fluids management strategies. Usual monitoring group - fluid management based on fluid responsiveness based by clinical sings. FATE group - fluid management based on focused transthoracic echocardiography data. |
| up to 24 hours |
| Comparison of septic shock incidence in both arms. | To compare the manifestation of septic shock (hemodynamics instability not responding to fluid administration, which requires norepinephrine infusion to maintain MAP ≥ 65 mmHg); | up to 30 days |
| Number of ICU-Free days. | To compare ICU free days in both groups. | up to 30 days |
| D013568 |
| Pathological Conditions, Signs and Symptoms |
| D059413 | Intraabdominal Infections |
| D010532 | Peritoneal Diseases |
| D004066 | Digestive System Diseases |