The Value of Peripheral Arterial Resistive Index in Evaluation of Tissue Perfusion in Patients With Septic Shock

Summary

In patients with septic shock, routine arterial blood pressure and central venous pressure are monitored in ICU. Conventional methods such as blood pressure and central venous pressure in septic patients cannot provide sufficient information in the follow-up due to the body's compensation mechanisms. The systemic vascular resistance index, which can be measured invasively or non-invasively with advanced hemodynamic monitoring methods, is a parameter that plays an important role in the management of septic patients.

Resistive index (Pourcelot Index) is an ultrasonic measurement method used to evaluate tissue perfusion and microcirculation. Since peripheral tissue perfusion is impaired in septic patients, the investigators think resistive index may be useful for management of sepsis. There are studies in the literature on the use of resistive index in the follow-up of patients.

The study will be about whether there is a correlation between the systemic vascular resistance index measured by cardiac output measurement, which is one of the advanced monitoring methods routinely used in the group requiring mechanical ventilation support in patients with septic shock, and the peripheral arterial resistive index, which is routinely used to evaluate tissue perfusion and microcirculation.

Conditions

• Shock, Septic

Interventions

DIAGNOSTIC_TEST

hemodynamic monitoring

Baxter Starling Monitor for measuring cardiac output and systemic vascular resistance (SVRI) which is using bioreactance technology. We need to place four electrodes on chest wall (upper left, upper right, down left, down right) and input monitor demographic parameters. Also enter mean arterial pressure (MAP) for calculating SVRI so we input MAP every minute.Patient bed set as 45 degree head elevated and legs 0 degree. Just after start measuring, monitor needs to synchronize itself for patient. After synchronisation we start fluid challenge with passive leg raising option. This test has two stages. First stage calculating baseline parameters which takes 3 minutes and second stage is measuring difference with fluid challenge which also takes 3 minutes. At the end of first stage monitor shows to perform passive leg raise and we perform trendelenburg maneuver till head comes to 0 degree. After second stage measurement has finished.

DIAGNOSTIC_TEST

resistive index

We use ultrasonography at the same time with cardiac output monitor in both stages. First we determine the location of radial artery at wrist snuffbox at 1.5 centimeters depth with linear probe and confirm pulsatile flow with color mode. In Starling's baseline stage we measure and calculate resistive index with doppler P-mode in triplex setting 3 times. When received 3 same result successively we noted as SBRI-1. Second measurement is initiated at last 30 seconds of passive leg raising as described before and we noted our measurement as SBRI-2

DIAGNOSTIC_TEST

Pleth variability index

During all stages Masimo Rad-87 rainbow probe is placed patients index or middle finger and we note PVI-1 and PVI-2 at the same time with SBRI-1 and SBRI-2

Sponsors & Collaborators

• Bezmialem Vakif University

  lead OTHER

Eligibility

Min Age

18 Years

Max Age

99 Years

Sex

ALL

Healthy Volunteers

No

Timeline & Regulatory

Start

2022-04-01

Primary Completion

2023-03-31

Completion

2023-03-31

Countries

• Turkey (Türkiye)

Study Locations