- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT05400343
Efficacy of Lung and Inferior Vena Cava Sonography for Fluid Optimization
Efficacy of Lung and Inferior Vena Cava Sonography for Fluid Optimization in Critically Ill Patients With Traumatic Brain Injury
Traumatic brain injury (TBI) is a leading cause of death and disability in trauma patients. As the primary injury cannot be reversed, management strategies must focus on preventing secondary injury by avoiding hypotension and hypoxia and maintaining appropriate cerebral perfusion pressure (CPP), which is a surrogate for cerebral blood flow (CBF). The goal should be euvolemia and avoidance of hypotension. The assessment of a patient's body fluid status is a challenging task for modern clinicians.
The use of Ultrasonography to assess body fluids has numerous advantages. The concept of using lung ultrasound for monitoring the patient is one of the major innovations that emerged from recent studies. Pulmonary congestion may be semiquantified using lung ultrasound and deciding how the patient tolerates fluid. Inferior vena cava (IVC) sonography and point-of-care ultrasound (POCUS) has become widely used as a tool to help clinicians prescribe fluid therapy. Common POCUS applications that serve as guides to fluid administration rely on assessments of the inferior vena cava to estimate preload and lung ultrasound to identify the early presence of extravascular lung water and avoid fluid over resuscitation In this study we will use the measurements of both lung and IVC together to guide fluid dosage in critically ill patients with TBI. We will also use ONSD as a mirror for intra-cranial pressure (ICP).
Study Overview
Status
Conditions
Detailed Description
The aim of this study is to detect the effectiveness of using IVC and lung ultrasound as bedside tools to ensure euvolemia in patients with traumatic brain injuries
Positive fluid balances have been associated with (angiographic) vasospasm, longer hospital length of stay and poor functional outcomes The assessment of a patient's body fluid status is a challenging task for modern clinicians. Currently, the most accurate method to guide fluid administration decisions uses "dynamic" measures that estimate the change in cardiac output that would occur in response to a fluid bolus. Unfortunately, their use remains limited due to required technical expertise, costly equipment, or applicability in only a subset of patients. Alternatively, point-of-care ultrasound (POCUS) has become widely used as a tool to help clinicians prescribe fluid therapy.
International recommendations suggest that the inferior vena cava (IVC) can be assessed to estimate the pressure in the right atrium of non-ventilated patients because of its collapsibility during inspiration. An IVC diameter of < 21mm with collapsibility of > 50% during inspiration suggests normal right atrium pressure (between 0 and 5 mmHg), whereas a diameter of > 21mm with collapsibility of < 50% suggests high pressure (between 10 and 20mmHg). The dynamic method of IVC evaluation, based on the variation in its diameter with respiration, enables the assessment of the potential benefit of fluid administration as a function of IVC compliance.
Ultrasonography of optic nerve sheath diameter (ONSD) in TBI patients has been shown to correlate with increased ICP and systemic reviews have supported this observation.
In this study, we will use the measurements of both lung and IVC together to guide fluid dosage in critically ill patients with TBI. We will also use ONSD as a mirror for ICP
The study investigates the effect of using bedside sonography in fluid assessment in a critically ill patient
Study Type
Enrollment (Anticipated)
Phase
- Not Applicable
Contacts and Locations
Study Contact
- Name: Mostafa M Saied, MD
- Phone Number: 00201223495380
- Email: mostafasaid1951@mans.edu.eg
Study Contact Backup
- Name: Medhat M Messeha, MD
- Phone Number: 00201207788199
- Email: medhatmikha70@yahoo.com
Study Locations
-
-
DK
-
Mansourah, DK, Egypt, 050
- Mansoura University
-
-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria:
- BMI less than 35 kg/m2
- Diagnosed with traumatic brain injury
- Glasgow coma score ≥ 4
Exclusion Criteria:
- Inability to get consent
- Presence of Increased intra-abdominal pressure,
- Presence of acute cor pulmonale
- Presence of severe right ventricular dysfunction.
- Pregnancy
- Patients with known pulmonary conditions that interfere with the interpretation of lung ultrasound like pneumectomy; pulmonary fibrosis; persistent pleural effusion
- Stage 5 chronic kidney disease
- indication for emergency renal replacement therapy (RRT)
Study Plan
How is the study designed?
Design Details
- Primary Purpose: DIAGNOSTIC
- Allocation: RANDOMIZED
- Interventional Model: PARALLEL
- Masking: SINGLE
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
ACTIVE_COMPARATOR: Standard care (control group)
fluid therapy will be guided by conventional ICU policies to maintain an adequate intravascular volume and good urine output
|
Following 24 hours from admission to the ICU, the standard care will be continued according to conventional ICU protocols The mean fluid intake will range from (2-3L per day) targeting zero or slightly negative balance (up to - 300ml). Various parameters will be used to attain this goal based on case-by-case clinical judgment.
All patients will receive the usual care for 24 hours according to ICU policies.
The main target is to maintain an adequate intravascular volume and good urine output.
The mean fluid intake will range from (2-3L per day) targeting zero or slightly negative balance (up to - 300ml).
Various parameters will be used to attain this goal based on case-by-case clinical judgment.
Lung sounds, heart rate, blood pressure, temperature, urine output, Lactate, haemoglobin, haematocrit, serum urea, creatinine, sodium, potassium, chloride, and bicarbonate values
|
EXPERIMENTAL: US-guided fluid management (active group)
Fluid therapy will be guided by measurements of lung and IVC sonography
|
All patients will receive the usual care for 24 hours according to ICU policies.
The main target is to maintain an adequate intravascular volume and good urine output.
The mean fluid intake will range from (2-3L per day) targeting zero or slightly negative balance (up to - 300ml).
Various parameters will be used to attain this goal based on case-by-case clinical judgment.
Lung sounds, heart rate, blood pressure, temperature, urine output, Lactate, haemoglobin, haematocrit, serum urea, creatinine, sodium, potassium, chloride, and bicarbonate values
Within 24 hours from admission to the ICU, IVC and lung sonography will be performed every other day and according to their measurements, the volume of fluid therapy will be adjusted.
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Cumulative Fluid balance
Time Frame: 10 days or until ICU discharge which comes first.
|
The difference between patient fluid intake and patient fluid output is recorded every 24 h then the cumulative balance is recorded
|
10 days or until ICU discharge which comes first.
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
ONSD as mirror for intracranial pressure.
Time Frame: every other day for 10 days or until ICU discharge which comes first
|
Ultrasonic examination will be performed by an experienced investigator with a 11-3 MHz linear transducer.
The patients will be examined in a supine position with the head elevated at 20-30° ONSD was defined as the distance between the external borders of the hyperechoic area 3 mm posterior to the point where the optic nerve entered the globe, using an electronic caliper along the axis perpendicular to the retina. .
To minimize intraobserver variability, each measurement was performed three times and the mean value was derived
|
every other day for 10 days or until ICU discharge which comes first
|
Urine output
Time Frame: 10 days or until ICU discharge which comes first
|
patient urine output per ml is collected and recorded every 6 hours and total daily urine output is recorded
|
10 days or until ICU discharge which comes first
|
Frequency of hypotension
Time Frame: every other day for 10 days or until ICU discharge which comes first
|
hypotension is defined as systolic blood pressure less than 90 mmHg, or diastolic blood pressure less than 50 mmHg or both or more than 20 % decline in basal blood pressure for more than 5 minutes.
|
every other day for 10 days or until ICU discharge which comes first
|
Duration of hypotension
Time Frame: 10 days or until ICU discharge which comes first
|
every other day for 10 days or until ICU discharge which comes first
|
10 days or until ICU discharge which comes first
|
Serum creatinine
Time Frame: 10 days or until ICU discharge which comes first
|
daily serum creatinine in mg /dl is ordered and recorded
|
10 days or until ICU discharge which comes first
|
Incidence of pulmonary edema
Time Frame: 10 days or until ICU discharge which comes first
|
Diagnosis of the patient with pulmonary edema by (x ray, CT, pulse oximetry, other methods) is recorded
|
10 days or until ICU discharge which comes first
|
Length of mechanical ventilation
Time Frame: 10 days or until ICU discharge which comes first
|
Duration of mechanical ventilation in days is record
|
10 days or until ICU discharge which comes first
|
Mortality at 10 days
Time Frame: mortality at day 10
|
mortality at day 10
|
Collaborators and Investigators
Sponsor
Investigators
- Study Chair: Mostafa M Saied, MD, Professor of Anesthesia and Surgical Intensive Care
- Study Director: Medhat M Messeha, MD, assistant professor of Anesthesia and Surgical Intensive Care
Study record dates
Study Major Dates
Study Start (ANTICIPATED)
Primary Completion (ANTICIPATED)
Study Completion (ANTICIPATED)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (ACTUAL)
Study Record Updates
Last Update Posted (ACTUAL)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Additional Relevant MeSH Terms
Other Study ID Numbers
- MFM-IRB, MD ∕ 22.01.591
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
IPD Plan Description
IPD Sharing Time Frame
IPD Sharing Access Criteria
IPD Sharing Supporting Information Type
- STUDY_PROTOCOL
- SAP
- ICF
- ANALYTIC_CODE
- CSR
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
Clinical Trials on Traumatic Brain Injury
-
Fondazione per la Ricerca Ospedale MaggioreCompletedBrain Injuries, Traumatic | Brain Injury Traumatic Severe | Brain Injury Traumatic ModerateItaly
-
Toronto Rehabilitation InstituteCentre for Aging and Brain Health Innovation; Ontario Neurotrauma FoundationUnknownBrain Injuries, Traumatic | Brain Injury, Chronic | Brain Injury Traumatic Severe | Brain Injury Traumatic ModerateCanada
-
Hospital Sirio-LibanesUniversity of Sao Paulo; Ministry of Health, Brazil; Hospital Sao Rafael; PROAD... and other collaboratorsRecruitingBrain Injury Traumatic Severe | Brain Injury Traumatic Moderate | Post Traumatic EpilepsyBrazil
-
University of TurkuTurku University Hospital; The Finnish Funding Agency for Technology and Innovation... and other collaboratorsCompletedBrain Injuries | TBI (Traumatic Brain Injury) | Brain Injuries, Traumatic | Traumatic Brain Injury | Injury, Brain, TraumaticFinland
-
Children's Hospital Medical Center, CincinnatiUniversity of CincinnatiCompletedBrain Injury Traumatic MildUnited States
-
BrainScope Company, Inc.RecruitingTBI (Traumatic Brain Injury) | Concussion, Brain | MTBI - Mild Traumatic Brain Injury | Closed Head InjuryUnited States
-
Institut National de la Santé Et de la Recherche...Institut National de Recherche en Informatique et en AutomatiqueNot yet recruitingTBI (Traumatic Brain Injury)France
-
University of Sao Paulo General HospitalUnknownTraumatic Brain Injury | Severe Brain Injury | Closed Traumatic Brain InjuryBrazil
-
Queen Mary University of LondonCompleted
-
Northeastern UniversityBrandeis UniversityRecruitingTraumatic Brain Injury | Mild Traumatic Brain Injury | TBI | Moderate Traumatic Brain InjuryUnited States
Clinical Trials on Standard care (control group)
-
Jewish General HospitalCanadian Association of Emergency PhysiciansCompletedHeart Failure | Emergencies | Acute Decompensated Heart Failure | FragilityCanada
-
M.D. Anderson Cancer CenterRecruitingGastrostomy | GastroEsophageal Cancer | GastricUnited States, Japan, Korea, Democratic People's Republic of
-
The University of Texas Health Science Center,...Active, not recruiting
-
Icahn School of Medicine at Mount SinaiNational Institute of Mental Health (NIMH)CompletedConduct Disorder | Oppositional Defiant DisorderUnited States
-
McMaster UniversityUniversity of Alberta; Macquarie University, Australia; Universidade Federal...CompletedLow Back Pain | Low Back Pain, RecurrentCanada
-
NYU Langone HealthCompletedDiabetes | GlycinemiaUnited States
-
University GhentResearch Foundation FlandersRecruitingAnterior Cruciate Ligament Reconstruction | ACL Injury | Athrogenic Muscle Responses | Arthrogenic Muscle InhibitionBelgium
-
Medical University of GrazCompleted
-
The University of Hong KongCompleted
-
Rush University Medical CenterNational Institute of Diabetes and Digestive and Kidney Diseases (NIDDK); John...Completed