Inferior Vena Cava Collapsibility and Distensibility Assessment in Critical Care.

(IVCIN TRIAL) Outcomes of Patient Admitted to Critical Care Unit With vs Without Inferior Vena Cava Collapsibility and Distensibility Assessment. A Randomized Clinical Trial in Pakistan.

This study will help in determining the impact of assessment of Inferior Vena Cava Collapsibility and Distensibility Index (IVC CI and DI) through Point Of Care Ultra Sound (POCUS), for the fluid management of critically ill patients. This would help in better management of such patients in resource limited countries, where costly equipment for cardiac output monitoring and fluid management are frequently not available.

Moreover this study will help in development of future guidelines for fluid resuscitation in critically ill patients.

The current study is a randomized clinical trial with the aim to explore comparative outcome between IVC CI and DI versus clinical parameters guided fluid management groups in patients of sepsis, Acute renal failure, Acute gastroenteritis and Diabetic ketoacidosis in terms of,

1. Within 24 hours 7 day and 28 day mortality
2. Change in Sequential Organ failure Assessment (ΔSOFA) score from baseline to 24 hours after fluid management.
3. Cumulative fluid balance at 6 hours of fluid management
4. Days on mechanical ventilation
5. Days in Intensive Care Unit (ICU)
6. Change in lactic acid levels in sepsis sub group
7. Change in Blood sugar Random (BSR) in Diabetic ketoacidosis (DKA) sub group
8. Change in Power of Hydrogen (PH) in septic and diabetic ketoacidosis sub group of participant

Inclusion Criteria:

• Patients admitted in critical care with systolic Blood Pressure < 90 mmHg with any of the diagnosis as per operational definition:
• Sepsis
• Diabetic ketoacidosis
• Acute kidney injury
• Acute gastroenteritis

Exclusion Criteria:

• Known case of right heart disease
• Known case of congestive cardiac failure
• Presence of marked ascites
• IVC could not be identified or diameter could not be measured
• Pregnant females
• Body Mass Index (BMI) >30 Kg/meter2