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Project properties
| Title | The use of repeated ultrasonographic measurements for the prediction of patient outcome in the critically ill. |
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| Keywords | ultrasound clinical diagnostics hemodynamics |
| Researchers |
Dr. I.C.C. van der Horst F. Keus R. Wiersema |
| Nature of the research | This prospective observational study evaluates the use of repeated measurements in terms of physical examination and ultrasonography for the evaluation of hemodynamic parameters and the prediction of short term organ failure and mortality. |
| Fields of study | intensive care |
| Background / introduction |
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Critically ill patients mostly suffer from circulatory shock or respiratory distress, with shock leading to mortality rates of up to 40%(1). After initial fluid resuscitation other complications of disease may arise. A consequence of treatment itself is fluid overload and multiple studies have shown the possible negative effects of - too much - fluid administration. Possibly this leads to venous congestion. Venous congestion entails venous fluid overload, manifested by for example an increased central venous pressure (CVP) or peripheral oedema (2). This venous congestion may contribute to the occurrence of short term organ failure after resuscitation by causing a high ‘’afterload’’ in the venous tracts of organs. There is no consensus on how to measure venous congestion. It is important to measure variables that may contribute to the development of venous congestion to identify those at risk and investigate whether venous congestion is associated with short term organ failure. Variables that could indicate venous congestion may be obtained using physical examination and biochemical analysis, but more importantly ultrasonography could provide information about perfusion, arterial and venous function (3). To best predict short term organ failure and mortality, these variables should be collected at multiple moments. Using repeated measures is likely to add dynamic information about the diagnostic and prognostic value of these variables. The dynamics of variables, in any direction, over time might improve the diagnostic accuracy and prognostic value of variables. This study will investigate the association between dynamic variables that reflect venous congestion and the development and occurrence of short term organ failure and mortality. |
| Research question / problem definition |
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| Do repeated measurements of variables reflecting hemodynamics better predict patient outcome when compared to singular measurements in critically ill patients? |
| Workplan |
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| This study is part of the Simple Intensive Care Studies (SICS). (4). In this research line several methods used for evaluating hemodynamic variables are evaluated in critically ill patients. For this research project the student will systematically perform repeated physical examination and conduct ultrasonographic measurements that reflect hemodynamic status. The student will be trained in performing Critical Care Ultrasonography (CCUS). The work will consist of a solid literature study, patient inclusion, data analysis and writing a thesis or report. There will always be other options for further participation in research if appropriate, or motivated students may suggest their own additional ideas or research question in line with the nature of the study. |
| References |
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1. Vincent J-L, De Backer D. Circulatory Shock. Finfer SR, Vincent J-L, editors. N Engl J Med [Internet]. 2013 Oct 31 [cited 2018 May 10];369(18):1726–34. Available from: http://www.nejm.org/doi/10.1056/NEJMra1208943 2. Chen KP, Cavender S, Lee J, Feng M, Mark RG, Celi LA, et al. Peripheral Edema, Central Venous Pressure, and Risk of AKI in Critical Illness. Clin J Am Soc Nephrol [Internet]. 2016 Apr 7 [cited 2018 May 10];11(4):602–8. Available from: http://www.ncbi.nlm.nih.gov/pubmed/26787777 3. Orso D, Paoli I, Piani T, Cilenti FL, Cristiani L, Guglielmo N. Accuracy of Ultrasonographic Measurements of Inferior Vena Cava to Determine Fluid Responsiveness: A Systematic Review and Meta-Analysis. J Intensive Care Med [Internet]. 2018 Jan 17 [cited 2018 May 10];088506661775230. Available from: http://journals.sagepub.com/doi/10.1177/0885066617752308 4. Hiemstra B, Eck RJ, Koster G, Wetterslev J, Perner A, Pettilä V, et al. Clinical examination, critical care ultrasonography and outcomes in the critically ill: cohort profile of the Simple Intensive Care Studies-I. BMJ Open [Internet]. 2017 Sep 27 [cited 2018 May 10];7(9):e017170. Available from: http://www.ncbi.nlm.nih.gov/pubmed/28963297 |
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