Carotid Doppler and IVC Measurements for Volume Guided Management in Acute Kidney Injury Patients

Study Overview
=================
Brief Summary
-----------------
Evaluate Inferior Vena Cava Indices (Diameters , IVC-CI)&carotid doppler measurements (corrected Carotid Flow Time ,Carotid Blood Flow ,Carotid Artery Peak Velocity Variations) as Non-Invasive Technique for volume guided management in AKI Patient. Estimate correlation between IVC (Diameters , IVC-CI) & carotid doppler measurements (corrected Carotid Flow Time ,Carotid Blood Flow ,Carotid Artery Peak Velocity Variations) as Non-Invasive Technique for volume guided management in AKI Patient.

Detailed Description
-----------------
Acute kidney injury affects increasing numbers of patients worldwide, it was estimated approximately 15% of all subjects treated in hospitals develop Acute kidney injury,even a small increase in serum creatinine may be associated with increased risk of mortality , Oliguric AKI it imposes a great challenge for fluid management. Recently, ultrasonography for estimating volume status has been widely recommended because of its non-invasive nature, ease of acquisition, and reproducibility of measurements.Among these ultrasound modalities, ultrasonographic assessment of the inferior vena cava & Carotid doppler measurements . In spontaneously breathing patients, the inferior vena cava (IVC) diameter and the IVC Collapsibility Index (IVC-CI) have been shown to correlate with the volume status and central venous pressure (CVP) . also has been shown to indicate fluid status in children , ventilated patients and healthy volunteers . corrected Carotid Flow Time (CFT) unaffected by respiration predicting fluid responsiveness that has shown promising results.Studies to date have shown that corrected CFT increases in response to fluid administration or consumption , and decreases in response to volume removal in dialysis and blood donation .

Official Title
-----------------
Carotid Doppler and Inferior Vena Cava Measuerments for Volume Guided Management in Acute Kidney Injury Patients

Conditions
-----------------
Acute Kidney Injury

Intervention / Treatment
-----------------
* Device: IVC ultrasound & Carotid doppler


Participation Criteria
=================
Eligibility Criteria
-----------------
Inclusion Criteria: Patients diagnosed with Acute Kidney Injury age must be more than 18 years Exclusion Criteria: Morbid obesity (BMI >35) End Stage Renal Disease (ESRD) on dialysis Sever ventricular dysfunction, valvular heart disease Carotid stenosis >50% chronic obstructive pulmonary disease. Pregnancy & tense ascites

Ages Eligible for Study
-----------------
Minimum Age: 18 Years

Sexes Eligible for Study
-----------------
All

Study Plan
=================
How is the study designed?
-----------------

Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Group A<br>patients whom fluid management will be guided by their IVC & carotid Doppler measurements | Device: IVC ultrasound & Carotid doppler<br>* bed side ultrasonographic assessement of inferior vena cava maximum and minimum diameters 2 to 5 cm caudal to its junction with the right atrium over a single respiratory cycle , inferior vena cava collapsibility index (IVC-CI) will calculated as (IVC max - IVC min)/IVC max). carotid doppler assessment (2-3 cm proximal to the carotid bulb in the longitudinal plane) of corrected carotid flow time(systole time/√cycle time) ,carotid artery peak velocity variation calculated as ([PV max- PV min]/PV mean) × 100, where PV mean = (PV max + PV min)/2. during three consecutive respiratory cycles. as part of their routine care and assessment<br>|
| Group B<br>patients in whom the fluid management will not guided by IVC & carotid Doppler measurements. | |

What is the study measuring?
-----------------
Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| percentage of participants with improved serum creatinine level in µmol/L in groups A and B. | percentage of participants with improved serum creatinine level in µmol/L in groups A and B. | at 48 hours | 
| percentage of participants with improved urine out put in ml/kg/h in groups A and B. | percentage of participants with improved urine out put in ml/kg/h in groups A and B. | at 48 hours | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| percentage of participants with improved mean arterial blood pressure in mmHg in groups A and B. | percentage of participants with improved mean arterial blood pressure in mmHg in groups A and B. | at 48 hours |