VEXUS-REA : Evaluation of Ultrasound Parameters of Venous Congestion in Patients in a Medical Intensive Care Unit

Condition(s) studied

Investigational drug(s) / intervention(s)

Venous ultrasound (inferior vena cava, portal vein, suprahepatic vein, and renal vein to calculate the VEXUS score ; femoral vein and popliteal vein): The research procedure consists of an abdominal venous ultrasound (inferior vena cava, portal vein, suprahepatic vein and renal vein) to calculate the VEXUS score, and a venous ultrasound of the lower limbs (femoral vein and popliteal vein). This procedure will be performed at the same time as the cardiac ultrasound (using the same equipment), which is a routine examination. This is a non-invasive, non-irradiating examination that has been proven to be safe. There are therefore no risks associated with the research.

Study summary

Shock is a common and serious cause of admission to intensive care. Vascular filling is one of the cornerstones of shock treatment, aimed at increasing cardiac output and restoring adequate organ perfusion through rapid intravenous administration of a solution. However, this vascular filling can be accompanied by venous congestion, which can be harmful. Fluid administration must therefore be sparing and carefully considered.

However, it is difficult to assess the correct amount of intravenous fluid to inject. Multi-site venous ultrasound (inferior vena cava, suprahepatic vein, portal vein, renal vein), recently published under a score called VExUS, could be a useful bedside tool for documenting venous congestion and avoiding excessive vascular filling. Nevertheless, this tool has been little evaluated in the general intensive care population, particularly in patients with acute respiratory distress syndrome (ARDS). Its link with other venous sites (femoral, popliteal) has also been little studied to date.

The main objective of our study is to describe the distribution of the VEXUS score among patients in a general intensive care unit.

The secondary objectives are:

* To study the feasibility of measuring the VEXUS score in patients with ARDS, including during prone positioning, a recommended and frequently used treatment for this condition, which could make it difficult to acquire venous ultrasound data.
* In this case, other more accessible venous flows could be analysed, namely the femoral venous flow and the popliteal venous flow. We will therefore also study their feasibility during prone positioning sessions.
* Subsequently, we will study the correspondence between the VEXUS score and these other types of venous flow (femoral, popliteal).
* Finally, we will evaluate the association between the VEXUS score in our general intensive care population and the long-term prognosis of patients, in this case death on day 28 and the occurrence of acute renal failure requiring renal replacement therapy during the intensive care stay.

Eligibility

Primary outcome measure(s)

• Distribution of the VEXUS score among all patients admitted (for any reason) in a general intensive care unit — From the inclusion of the first patient to the 525th patient (approximately 9 months)
  Describe the distribution of the VEXUS score among all patients admitted (for any reason) in a general intensive care unit at Besançon Teaching Hospital (Besançon, city, FRANCE).

Trial sites (1)

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