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Echocardiography is recommended for the hemodynamic management of patients with shock. Recently, a new echocardiographic method has been proposed that provides a non-invasive measurement of myocardial work incorporating different components, namely total myocardial work (GWI), constructive myocardial work (GCW), lost myocardial work (GWW) and effective myocardial work (GWE). Echocardiographic measurement of myocardial work takes into account both myocardial deformation and left ventricular afterload (estimated by measuring systolic blood pressure) and, unlike the measurement of left ventricular ejection fraction and global longitudinal strain, could be less dependent on cardiac load conditions, particularly left ventricular afterload. To date, non-invasive measurement of myocardial work has never been validated in critically ill patients, and no study has assessed the effects of different therapies (fluids administration, administration of norepinephrine) on the different components of myocardial work in patients admitted to intensive care unit.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Fluids | Experimental |
| |
| Norepinephrine | Experimental |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Fluid administration | Other | Patients will receive fluid administration (500 mL of saline over 30 minutes). The indication of fluid administration will be left to the discretion of the attending physician. |
| Measure | Description | Time Frame |
|---|---|---|
| Determine the feasibility of echocardiographic measurement | The primary outcome will be assess by evaluating the proportion of patients in whom non-invasive echocardiographic measurement of myocardial work is obtained. | through study completion, an average of 1 year |
| Measure | Description | Time Frame |
|---|---|---|
| measurement of myocardial by cardiac ultrasound during fluid administration | The measurement of myocardial work will be performed non-invasively by cardiac ultrasound. The secondary outcomes will be assess the impact of fluid administration on the different components of myocardial work. as follows: (i) fluid-induced changes in the different components of myocardial work, (ii) concordance between changes in myocardial work and changes in cardiac output induced by fluid administration (iii), the ability of the different components of myocardial work to predict fluid responsiveness. |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Mathieu Jozwiak, MD | Contact | +33492035510 | jozwiak.m@chu-nice.fr |
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| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| CHU de NICE ARCHET | Nice | CHU de Nice | 06000 | France |
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| ID | Term |
|---|---|
| D055103 | Hypodermoclysis |
| ID | Term |
|---|---|
| D055104 | Infusions, Subcutaneous |
| D007263 | Infusions, Parenteral |
| D004333 | Drug Administration Routes |
| D004358 | Drug Therapy |
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| Norepinephrine administration or increase in norepinephrine dosage | Other | Patients will receive norepinephrine or norepinephrine dosage will be increased if necessary to achieve the appropriate mean arterial pressure level. The indication of norepinephrine administration or increase in norepinephrine dosage will be left to the discretion of the attending physician. |
|
| through study completion, an average of 1 year |
| measurement of myocardial by cardiac ultrasound norepinephrine administration | The measurement of myocardial work will be performed non-invasively by cardiac ultrasound. The secondary outcomes will be assess the impact of norepinephrine administration on the different components of myocardial work. as follows: (i) norepinephrine-induced changes in the different components of myocardial work, (ii) concordance between changes in myocardial work and changes in cardiac output induced by norepinephrine and (iii), the ability of the different components of myocardial work to predict fluid responsiveness. | through study completion, an average of 1 year |
| CHU de NICE PASTEUR | Nice | CHU de Nice | 06000 | France |
|
| Aphm Hopital La Timone | Marseille | France |
|
| D013812 |
| Therapeutics |
| D005440 | Fluid Therapy |