Identify fluid responsive patients with sepsis in the Emergency Depart
Research type
Research Study
Full title
An observational study using non-invasive cardiac output monitoring to identify the proportion of patients with sepsis admitted via the Emergency Department who increase their cardiac output in response to a fluid bolus.
IRAS ID
203831
Contact name
Tim Harris
Contact email
Sponsor organisation
Barts Health NHS Trust
Duration of Study in the UK
0 years, 7 months, 3 days
Research summary
This is an observational study that aims to identify the proportion of patients presenting to the Emergency Department (ED) with sepsis/severe sepsis/septic shock that increase their cardiac out put by >=10% in response to a fluid bolus ('fluid responders') using a non-invasive cardiac output monitor (NICOM by Cheetah).
In patients that are volume deplete, such as in sepsis and dehydration, intravenous fluid resuscitation is administered to improve tissue perfusion and oxygen delivery. Fluid dosing in the ED remains largely empiric with little knowledge of how fluid doses alter cardiac performance. No published studies have identified the proportion of patients in the Emergency Department (ED) who increase cardiac output and stroke volume with subsequent boli of fluid.Studies based in the intensive care unit suggest the proportion is around 50.% Identifying fluid responders, defined as a greater than 10% increase in stroke volume after an addition of 500 ml of fluid into the circulation, can help treating ED physicians optimise their fluid resuscitation in volume deplete patients. Previous studies, mainly performed in the intensive care environment, have identified an increased mortality in both patients who receive inadequate fluid resuscitation and patients who are fluid overloaded.
Previous work from our group found the NICOM by Cheetah to be the most applicable noninvasive cardiac monitor in the ED setting with readings obtained in 98% of patients. This device is simple to use and may be applied by both medical and nursing staff.
Our study aims to find the proportion of fluid responders and characterize stroke volume and cardiac output changes in response to fluid therapy in the ED. This data will inform a randomised trial of fluid therapy based on identifying patients who increase their stroke volume in response to a standard fluid bolus and thus potentially benefit from this intervention.REC name
Yorkshire & The Humber - Leeds East Research Ethics Committee
REC reference
16/YH/0321
Date of REC Opinion
7 Sep 2016
REC opinion
Further Information Favourable Opinion