Overview
The goal of this prospective observational study is to analyse change in VO2 and VCO2 measured via a dedicated ventilator after hemodynamic optimization maneuvers in adult patients admitted to the ICU with any sign of shock.
The main questions it aims to answer are:
- Do common maneuvers for hemodynamic optimization (fluid bolus and/or vasopressor administration) have any impact on tissue perfusion in terms of oxygen consumption (VO2) and carbon dioxide production (VCO2) measured by a dedicated ventilator?
- Are the values measured by exhaled gas comparable to those calculated by the measurement of dissolved veno-arterial gas?
Participants enrolled in the study will receive advanced hemodynamic monitoring with MostCare Up (Vygon ®) and their hemodynamic instability will be managed according to most recent guidelines and based on clinical decision of treating physicians.
Eligibility
Inclusion Criteria:
Hypotension (MAP< 65mmHg or sudden drop in MAP > 15 mmHg) and one of the following conditions:
- Heart rate > 120 bpm
- Urinary output < 0.5 ml/kg/h for at least two hours
- Lactate > 2 mmol/L
Exclusion Criteria:
- Urgent need for surgery
- Urgent need for veno-arterial ECMO or severe hemodynamic instability
- Consistent risk of imminent death
- Severe ARDS or severe respiratory failure (p/F < 100 mmHg) and/or FiO2>0.8
- Severe heart failure (NYHA 4 and/or EF<25%)
- Need for intermittent or continuous renal replacement therapy (IRRT or CRRT)
- Anemia defined as Hb<8 g/dL
- VO2 variability < 5% throughout ten minutes of stabilization before procedure start
- Intraabdominal hypertension, defined as intraabdominal pressure > 18 mmHg
- Pregnancy
- Withdrawal or refuse of informed consent
- Terminal disease
- Do-not-resuscitate order.