Ventriculo-arterial Coupling and Myocardial Work in Sepsis and Septic Shock

NCT ID: NCT06853574

Last Updated: 2025-03-03

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

NOT_YET_RECRUITING

Clinical Phase

NA

Total Enrollment

30 participants

Study Classification

INTERVENTIONAL

Study Start Date

2025-02-28

Study Completion Date

2025-06-30

Brief Summary

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Sepsis is a term which describes an excessive response of the body to an infection and, if not promptly treated, can turn into septic shock a condition in which the organs don't receive enough oxygen to satisfy their needs. The aim of the study is to assess how the treatment of sepsis and septic shock will modify myocardial work and ventriculo-arterial coupling, that can be considered as indicators of ventricular and arterial performance efficacy respectively. Each patient will be treated according to updated guidelines for sepsis and septic shock management, they will voluntarily be enrolled and they can decide to withdraw in each moment without any consequence on their treatment. The investigators, after receiving the consent, will collect patients' data, take blood samples and perform ultrasound measurements and then will start the treatment which can be based on fluids infusion, vasopressors or both. The investigators think that a modern cardiovascular assessment approach can be used to individually set the optimal blood pressure target in sepsis and septic shock with the combined evaluation of myocardial work and ventriculo-arterial coupling.

Detailed Description

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Conditions

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Sepsis Septic Shock

Study Design

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Allocation Method

NON_RANDOMIZED

Intervention Model

CROSSOVER

Primary Study Purpose

BASIC_SCIENCE

Blinding Strategy

NONE

Study Groups

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Fluids

The patients will be included in this arm on admission basing on the absence of peripheral edema, presence of apical A lines at lung ultrasound, inferior vena cava width \< 2 cm and velocity-time integral (VTI) variation \> 10%.

If the fluid therapy will not be effective, patients will also receive vasopressors.

Group Type ACTIVE_COMPARATOR

Fluid therapy

Intervention Type DRUG

Infusion of 8 ml/Kg/30' or 16 ml/kg/60' of fluids.

Noradrenaline infusion

Intervention Type DRUG

dosage will be titrated in order to obtain mean arterial pressure target

No fluids

The patients will be included in this arm on admission basing on the presence of peripheral edema, presence of apical B lines at lung ultrasound, inferior vena cava width \> 2 cm and velocity-time integral (VTI) variation \< 10%.

In this arm the patients will receive vasopressors with an initial mean arterial pressure target of 65 mmHg; then the investigators will target to 80-85 mmHg to observe tha changes in ventriculo-arterial coupling.

Group Type ACTIVE_COMPARATOR

Noradrenaline infusion

Intervention Type DRUG

dosage will be titrated in order to obtain mean arterial pressure target

Interventions

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Fluid therapy

Infusion of 8 ml/Kg/30' or 16 ml/kg/60' of fluids.

Intervention Type DRUG

Noradrenaline infusion

dosage will be titrated in order to obtain mean arterial pressure target

Intervention Type DRUG

Other Intervention Names

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Vasopressin infusion

Eligibility Criteria

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Inclusion Criteria

* 18 or more years old
* sepsis
* septic shock

Exclusion Criteria

* lack of consent
* less than 18 years old
* pregnancy
* more than moderate aortic stenosis ( aortic valve area (AVA) \< 1.4 cm2, aortic valve area indexed (AVAi) \< 0.85, doppler velocity index (DVI) \< 0.5)
* more than mild mitral regurgitation (vena contracta (VC) width \<= 3 mm, mitral regurgitation (MR) effective regurgitant orifice area (EROA) \< 20, MR regurgitant volume (RegV) \< 30 ml)
* cardiac arrythmias (e.g. atrial fibrillation/flutter, frequent ventricular and supraventricular or nodal activity)
* renal replacement therapy
* other than continous modes of mechanical ventilation
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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General and Teaching Hospital Celje

OTHER

Sponsor Role lead

Responsible Party

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Matej Podbregar

Prof. Dr. Matej Podbregar

Responsibility Role PRINCIPAL_INVESTIGATOR

Locations

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General Hospital Celje

Celje, , Slovenia

Site Status

Countries

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Slovenia

Central Contacts

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Matej Prof. Dr. Podbregar, Intensive care medicine

Role: CONTACT

+38640215960

Andrea Dr. D'Angelo, Emergency medicine resident

Role: CONTACT

+393313550085

Facility Contacts

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Matej Podbregar

Role: primary

0038640215960

References

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Sunagawa K, Sagawa K, Maughan WL. Ventricular interaction with the loading system. Ann Biomed Eng. 1984;12(2):163-89. doi: 10.1007/BF02584229.

Reference Type BACKGROUND
PMID: 6507965 (View on PubMed)

Kakihana Y, Nishida O, Taniguchi T, Okajima M, Morimatsu H, Ogura H, Yamada Y, Nagano T, Morishima E, Matsuda N; J-Land 3S Study Group. Efficacy and safety of landiolol, an ultra-short-acting beta1-selective antagonist, for treatment of sepsis-related tachyarrhythmia (J-Land 3S): a multicentre, open-label, randomised controlled trial. Lancet Respir Med. 2020 Sep;8(9):863-872. doi: 10.1016/S2213-2600(20)30037-0. Epub 2020 Mar 31.

Reference Type BACKGROUND
PMID: 32243865 (View on PubMed)

Morelli A, Ertmer C, Westphal M, Rehberg S, Kampmeier T, Ligges S, Orecchioni A, D'Egidio A, D'Ippoliti F, Raffone C, Venditti M, Guarracino F, Girardis M, Tritapepe L, Pietropaoli P, Mebazaa A, Singer M. Effect of heart rate control with esmolol on hemodynamic and clinical outcomes in patients with septic shock: a randomized clinical trial. JAMA. 2013 Oct 23;310(16):1683-91. doi: 10.1001/jama.2013.278477.

Reference Type BACKGROUND
PMID: 24108526 (View on PubMed)

Nasrollahi-Shirazi S, Sucic S, Yang Q, Freissmuth M, Nanoff C. Comparison of the beta-Adrenergic Receptor Antagonists Landiolol and Esmolol: Receptor Selectivity, Partial Agonism, and Pharmacochaperoning Actions. J Pharmacol Exp Ther. 2016 Oct;359(1):73-81. doi: 10.1124/jpet.116.232884. Epub 2016 Jul 22.

Reference Type BACKGROUND
PMID: 27451411 (View on PubMed)

Zhou X, Pan J, Wang Y, Wang H, Xu Z, Zhuo W. Left ventricular-arterial coupling as a predictor of stroke volume response to norepinephrine in septic shock - a prospective cohort study. BMC Anesthesiol. 2021 Feb 17;21(1):56. doi: 10.1186/s12871-021-01276-y.

Reference Type BACKGROUND
PMID: 33596822 (View on PubMed)

Chen CH, Fetics B, Nevo E, Rochitte CE, Chiou KR, Ding PA, Kawaguchi M, Kass DA. Noninvasive single-beat determination of left ventricular end-systolic elastance in humans. J Am Coll Cardiol. 2001 Dec;38(7):2028-34. doi: 10.1016/s0735-1097(01)01651-5.

Reference Type BACKGROUND
PMID: 11738311 (View on PubMed)

Zhou X, Zhang Y, Pan J, Wang Y, Wang H, Xu Z, Chen B, Hu C. Optimizing left ventricular-arterial coupling during the initial resuscitation in septic shock - a pilot prospective randomized study. BMC Anesthesiol. 2022 Jan 21;22(1):31. doi: 10.1186/s12871-021-01553-w.

Reference Type BACKGROUND
PMID: 35062874 (View on PubMed)

Antonini-Canterin F, Poli S, Vriz O, Pavan D, Bello VD, Nicolosi GL. The Ventricular-Arterial Coupling: From Basic Pathophysiology to Clinical Application in the Echocardiography Laboratory. J Cardiovasc Echogr. 2013 Oct-Dec;23(4):91-95. doi: 10.4103/2211-4122.127408.

Reference Type BACKGROUND
PMID: 28465893 (View on PubMed)

Andrei S, Bahr PA, Berthoud V, Popescu BA, Nguyen M, Bouhemad B, Guinot PG. Diuretics depletion improves cardiac output and ventriculo-arterial coupling in congestive ICU patients during hemodynamic de-escalation. J Clin Monit Comput. 2023 Aug;37(4):1035-1043. doi: 10.1007/s10877-023-01011-7. Epub 2023 Apr 25.

Reference Type BACKGROUND
PMID: 37097337 (View on PubMed)

Bischoff AR, Stanford AH, McNamara PJ. Short-term ventriculo-arterial coupling and myocardial work efficiency in preterm infants undergoing percutaneous patent ductus arteriosus closure. Physiol Rep. 2021 Nov;9(22):e15108. doi: 10.14814/phy2.15108.

Reference Type BACKGROUND
PMID: 34806325 (View on PubMed)

Demailly Z, Besnier E, Tamion F, Lesur O. Ventriculo-arterial (un)coupling in septic shock: Impact of current and upcoming hemodynamic drugs. Front Cardiovasc Med. 2023 May 30;10:1172703. doi: 10.3389/fcvm.2023.1172703. eCollection 2023.

Reference Type BACKGROUND
PMID: 37324631 (View on PubMed)

Rehn M, Chew MS, Olkkola KT, Ingi Sigurethsson M, Yli-Hankala A, Hylander Moller M. Surviving sepsis campaign: International guidelines for management of sepsis and septic shock in adults 2021 - endorsement by the Scandinavian society of anaesthesiology and intensive care medicine. Acta Anaesthesiol Scand. 2022 May;66(5):634-635. doi: 10.1111/aas.14045. Epub 2022 Mar 6.

Reference Type BACKGROUND
PMID: 35170043 (View on PubMed)

Provided Documents

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Document Type: Study Protocol, Statistical Analysis Plan, and Informed Consent Form

View Document

Other Identifiers

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70/2025/6-1

Identifier Type: -

Identifier Source: org_study_id

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