The Impact of Focused Transthoracic Echocardiography in Urgent Abdominal Surgery for Septic Patients

Study Overview
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Brief Summary
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The aim of the study is to identify the diagnostic value of the focused assessed echocardiography in septic patients undergoing urgent abdominal surgery due to peritonitis. The investigators expect that the incidence of hemodynamic instability will be reduced and the survival of the patients will be improved.

Detailed Description
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Often sepsis remains undiagnosed at the very beginning because of the concentration to the surgical pathology in perioperative period. This results in unacceptably high mortality. The investigators hypothesize that extended hemodynamic monitoring by focused transthoracic echocardiography will personalize early fluid resuscitation which will improve patient's outcome. The goals of the investigators study are: To conduct two-group randomized controlled clinical trial to compare patient management based on standard monitoring and extended hemodynamic monitoring by focused transthoracic echocardiography in patients undergoing urgent abdominal surgery due to peritonitis. To demonstrate that patient management based on extended hemodynamic monitoring by focused echocardiography results in improved survival, reduced incidence of hemodynamic instability during perioperative period. To compare an amount of administrated of intravenous fluids in both groups. The investigators hypothesize that focused echocardiography monitoring will result in more administrated intravenous fluids during perioperative period.

Official Title
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The Impact of Extended Hemodynamic Monitoring by Focused Transthoracic Echocardiography in Urgent Abdominal Surgery for Septic Patients

Conditions
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Sepsis, Hypovolemia, Peritonitis

Intervention / Treatment
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* Other: Focused assessed echocardiography


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Age more than 18 years old. Patients undergoing urgent abdominal surgery due to diffuse peritonitis. SOFA score >2. Patients who sign an agreement to participate in the study. Exclusion Criteria: Younger than 18 years old. Known pregnancy. Unconscious patients or those who do not agree to participate in the study. Contraindication to central venous or arterial catheterization. Patients who were already treated in ICU because of sepsis or septic shock before this surgery. Known chronic renal failure. Re-laparotomy. Peritonitis due to acute mesenteric ischaemia, thrombosis or trauma. Dying patients.

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| No Intervention: Non-echo group<br>Patients get the standard monitoring and treatment based on Good medical practice. Extended monitoring by focused echocardiography is not applied for this group. | |
| Experimental: Focussed echocardiography group<br>The extended cardiac monitoring by focused assessed transthoracic echocardiography is applied. | Other: Focused assessed echocardiography<br>* Focused assessed transthoracic echocardiography is non-invasive, painless procedure. The transducer is placed on the chest at certain locations and angles to get the required information on patient's condition.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Inpatient mortality in both treatment arms. | Comparison of 30 days intra-hospital mortality in both arms. | 30 days intra-hospital mortality | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Comparison of incidence of severe hypotension MAP <65 mmHg after anaesthesia induction in both arms. | To evaluate the incidence of severe hypotension after anesthesia induction (1 - 5 minutes after induction) in both groups. | 1-5 minutes after anaesthesia induction. | 
| Comparison of fluid management in both arms (from hospitalisation to the surgery, during the surgery, after the surgery up to 24 hours). | Comparison of tow fluids management strategies. Usual monitoring group - fluid management based on fluid responsiveness based by clinical sings. FATE group - fluid management based on focused transthoracic echocardiography data. | up to 24 hours | 
| Comparison of septic shock incidence in both arms. | To compare the manifestation of septic shock (hemodynamics instability not responding to fluid administration, which requires norepinephrine infusion to maintain MAP ≥ 65 mmHg); | up to 30 days | 
| Number of ICU-Free days. | To compare ICU free days in both groups. | up to 30 days | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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sepsis, echocardiography, urgent, abdominal surgery