POCUS GUIDED FLUID RESUSCITATION IN CIRRHOSIS
Research type
Research Study
Full title
Point of care ultrasound guided fluid resuscitation in hospitalised patients with decompensated cirrhosis
IRAS ID
349508
Contact name
Gemma Wells
Contact email
Sponsor organisation
University College London
Duration of Study in the UK
1 years, 0 months, 1 days
Research summary
When people with liver cirrhosis present to hospital, our first line therapy is intravenous albumin to treat infection/sepsis and prevent kidney failure. All guidelines recommend a fluid resuscitation regimen based on patients’ weights. However, despite this being standard of care for many years, 2 recent large trials have highlighted the potential serious effects of fluid overload following albumin infusions causing pulmonary oedema (fluid on the lungs) and leading to poor outcomes associated with albumin use. Furthermore, heart failure has been increasingly recognized in these patients, which increases their tendency to develop fluid overload.
Point of care ultrasound guided fluid management interventions (POCUS) with images downloaded onto users’ mobile phones is being increasingly used as a bedside tool to assess volume status and haemodynamics in hospitalized patients. Ultrasonographic measurements of the major blood vessel returning blood to the heart, the inferior vena cava (diameter and collapsibility) have been shown to be a useful non-invasive method to estimate the fluid resuscitation staus of the patient. Benefit has been shown for use in (non-cirrhosis) patients with shock, suspected sepsis and trauma in the emergency room or intensive care units. This could offer a precision approach to albumin administration that could improve efficacy and reduce harm.
We will perform an observational study in patients with cirrhosis, taking POCUS readings before and after fluid has been given by their clinical teams, to assess how changes in readings relate to clinical outcomes and better understand if patients might benefit from POCUS. The readings take 10 minutes and do not hurt. Pseudonymised data will be stored securely. Blood samples may also be taken to assess markers of heart and kidney function,
We will use data generated to design a phase II safety and efficacy study to assess whether use of POCUS might improve clinical care in cirrhosis.REC name
London - Hampstead Research Ethics Committee
REC reference
25/PR/0801
Date of REC Opinion
17 Jul 2025
REC opinion
Further Information Favourable Opinion