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. 2023 Jul 24;13(7):e074843.
doi: 10.1136/bmjopen-2023-074843.

Doppler identified venous congestion in septic shock: protocol for an international, multi-centre prospective cohort study (Andromeda-VEXUS)

Ross Prager  1 , Eduardo Argaiz  2   3 , Michael Pratte  4 , Philippe Rola  5 , Robert Arntfield  6 , William Beaubien-Souligny  7 , André Y Denault  8 , Korbin Haycock  9 , Francisco Miralles Aguiar  10 , Jan Bakker  11   12 , Gustavo Ospina-Tascon  13   14 , Nicolas Orozco  15   16 , Bram Rochwerg  17   18 , Kimberley Lewis  17   18 , Ibrahim Quazi  18 , Eduardo Kattan  12 , Glenn Hernandez  19 , John Basmaji  6
Affiliations

Doppler identified venous congestion in septic shock: protocol for an international, multi-centre prospective cohort study (Andromeda-VEXUS)

Ross Prager et al. BMJ Open. .

Abstract

Introduction: Venous congestion is a pathophysiological state where high venous pressures cause organ oedema and dysfunction. Venous congestion is associated with worse outcomes, particularly acute kidney injury (AKI), for critically ill patients. Venous congestion can be measured by Doppler ultrasound at the bedside through interrogation of the inferior vena cava (IVC), hepatic vein (HV), portal vein (PV) and intrarenal veins (IRV). The objective of this study is to quantify the association between Doppler identified venous congestion and the need for renal replacement therapy (RRT) or death for patients with septic shock.

Methods and analysis: This study is a prespecified substudy of the ANDROMEDA-SHOCK 2 (AS-2) randomised control trial (RCT) assessing haemodynamic resuscitation in septic shock and will enrol at least 350 patients across multiple sites. We will include adult patients within 4 hours of fulfilling septic shock definition according to Sepsis-3 consensus conference. Using Doppler ultrasound, physicians will interrogate the IVC, HV, PV and IRV 6-12 hours after randomisation. Study investigators will provide web-based educational sessions to ultrasound operators and adjudicate image acquisition and interpretation. The primary outcome will be RRT or death within 28 days of septic shock. We will assess the hazard of RRT or death as a function of venous congestion using a Cox proportional hazards model. Sub-distribution HRs will describe the hazard of RRT given the competing risk of death.

Ethics and dissemination: We obtained ethics approval for the AS-2 RCT, including this observational substudy, from local ethics boards at all participating sites. We will report the findings of this study through open-access publication, presentation at international conferences, a coordinated dissemination strategy by investigators through social media, and an open-access workshop series in multiple languages.

Trial registration number: NCT05057611.

Keywords: acute renal failure; adult intensive & critical care; diagnostic imaging; infectious diseases.

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Conflict of interest statement

Competing interests: AD has the following disclosures, however, none are relevant to this current research: CAE-Healthcare (2010) speaker bureau, (2020) KOL speaker bureau, Masimo (2017) speaker bureau, Edwards (2019) research (equipment grant) and supported by the Richard I. Kaufman Endowment Fund in Anesthesia and Critical Care (2015). EA has the following disclosures, however, it is not relevant or discussed in this current research: Speaker honoraria from EchoNous. The remaining authors have relevant conflict of interest to declare.

Figures

Figure 1
Figure 1
Doppler markers of venous congestion for the hepatic vein, porta vein and intrarenal veins.
Figure 2
Figure 2
Renal venous stasis index for intrarenal veins Doppler.
Figure 3
Figure 3
Inferior vena cava measurements in long and short axis.
See this image and copyright information in PMC

References

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