Central Venous Pressure (CVP) Changes do Not Predict Preload Unresponsiveness

NCT ID: NCT03753672

Last Updated: 2019-02-22

Basic Information

• Recruitment Status: UNKNOWN
• Total Enrollment: 45 participants
• Study Classification: OBSERVATIONAL
• Study Start Date: 2017-12-10
• Study Completion Date: 2019-06-30

Brief Summary

Passive leg raising (PLR) is routinely used to predict preload responsiveness in critically ill patients. However, real-time measurements of cardiac output are required to assess its effects. Some authors have suggested that in fluid non-responders, central venous pressure (CVP) increased markedly. By analogy with the CVP rules proposed by Weill et al to assess a fluid challenge, it has been hypothesized that an increase in CVP ≥ 5 mmHg during PLR can predict preload unresponsiveness.

Objective Investigation of whether an increase in CVP ≥ 5 mmHg during PLR predict preload unresponsiveness diagnosed by the absence of increase in velocity-time integral (VTI) of the flow in the left ventricular outflow tract by more than 10% (4).

Methods Critically ill patients with a central venous catheter in place and for whom the physician decided to test preload responsiveness by PLR were prospectively included. Transthoracic echocardiography was performed to obtain VTI. The CVP and VTI were measured before and during PLR.

Conditions

Cardiovascular Shock

Study Design

• Observational Model Type: COHORT
• Study Time Perspective: PROSPECTIVE

Study Groups

preload responsive

defined as an increase in Velocity time integral of the sub-aortic flow greater or equal to 10%

preload responsiveness

Intervention Type: DIAGNOSTIC_TEST

We investigated whether an increase in CVP ≥ 5 mmHg during PLR predict preload unresponsiveness diagnosed by the absence of increase in velocity-time integral (VTI) of the flow in the left ventricular outflow tract by more than 10%

preload unresponsive

defined as an increase in Velocity time integral of the sub-aortic flow lower than 10%

preload responsiveness

Intervention Type: DIAGNOSTIC_TEST

We investigated whether an increase in CVP ≥ 5 mmHg during PLR predict preload unresponsiveness diagnosed by the absence of increase in velocity-time integral (VTI) of the flow in the left ventricular outflow tract by more than 10%

Interventions

preload responsiveness

We investigated whether an increase in CVP ≥ 5 mmHg during PLR predict preload unresponsiveness diagnosed by the absence of increase in velocity-time integral (VTI) of the flow in the left ventricular outflow tract by more than 10%

Intervention Type: DIAGNOSTIC_TEST

Eligibility Criteria

Inclusion Criteria

• ADULTS
• Patients presenting with shock or other signs of circulatory failure (tachycardia, oliguria)
• Need for the physician to test preload responsiveness
• Patients already equipped by a central venous catheter for the measurement of CVP

Exclusion Criteria

• patients<18 years old
• pregnancy
• instaility justifying rapid increase in cathecolamines

• Eligible Sex: ALL
• Accepts Healthy Volunteers: No

Sponsors

Hopital Antoine Beclere

OTHER

Sponsor Role: lead

Responsible Party

Hamzaoui Olfa

principal investigator

Responsibility Role: PRINCIPAL_INVESTIGATOR

Locations

Hamzaoui Olfa

Clamart, , France

Site Status: RECRUITING

Countries

France

Facility Contacts

OLFA HAMZAOUI, MD

Role: primary

olfa.hamzaoui@abc.aphp.fr

0033145374957

References

Hamzaoui O, Gouezel C, Jozwiak M, Millereux M, Sztrymf B, Prat D, Jacobs F, Monnet X, Trouiller P, Teboul JL. Increase in Central Venous Pressure During Passive Leg Raising Cannot Detect Preload Unresponsiveness. Crit Care Med. 2020 Aug;48(8):e684-e689. doi: 10.1097/CCM.0000000000004414.

Reference Type: DERIVED

PMID: 32697509 (View on PubMed)

Other Identifiers

2017-A03578-45

Identifier Type: -

Identifier Source: org_study_id