Assessing the response to vascular filling in shock is a challenge in emergency medicine.
The mitral annulus velocity measured by tissue Doppler (E') has recently been characterized as sensitive to the preload conditions of a patient.
The investigators hypothesize that the E' variation (∆E') before and after fluid filling allows us to assess the response to vascular filling. The investigators hypothesize that the ∆E' has a good diagnostic performance to establish whether a patient is responsive to fluid filling, defined by an area under the ROC curve greater than 0.75.
Patient has been informed of the study and does not refuse to participate.
Patient is at least ≥ 18 years of age.
The patient must be beneficiary of a health insurance plan.
Patient has shock with a mean blood pressure less than 65 mmHg (<)
The patient has already received 2 vascular fillings since the beginning of his management
The patient is in shock and has a contraindication to vascular filling : shock of a cardiogenic or obstructive nature
The patient has an intracranial pathology requiring maintain a MAP ≥ 80 mmHg
The patient is intubated or on Non-Invasive Ventilation before the vascular filling
The study population consisted of patients with shock (MAP \< 65 mmHg) requiring vascular filling indicated by the referring physician physician, recruited consecutively in the emergency department of the CHU of Nîmes and Montpellier.
Cohort
Prospective
Cardiac ultrasonography
Diagnostic testDuring the inclusion visit, the patient will receive 3 cardiac ultrasonography. The first one will be performed at the time of the initiation of the 500mL vascular filling (T0), without delaying and the second one after the end of the filling (Tfin). These first two ultrasound are part of standard practice. A third will be performed 20 minutes after the end of the vascular filling (Tfin+20).
E' variation (∆E')
The E' wave will be measured by tissue Doppler at the initiation (T0) of the filling and after the end of the vascular (Tfin) to determine its variation (%) between these two times of measurement.
Fluid filling responsiveness
Vascular filling is defined by the intravenous administration of 500 mL of crystalloid for 20 to 30 minutes, decided by the physician in charge. The response to filling will be evaluated by the variation of the time velocity index between T0 and Tfin (∆ITV) measured with pulsed Doppler. Patients will be considered : * Responder (R) group if ∆ITV ≥ 15% * Nonresponder group (NR) if ∆ITV \< 15%.
∆E'late
∆E'late: the E' wave will be measured by trans thoracic ultrasound before vascular filling (T0) and 20 minutes after the end of vascular filling (Tfin+20) to determine its variation (%) between these two times of measurement.
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