Shock is a common and serious cause of admission to intensive care. Vascular filling is one of the cornerstones of shock treatment, aimed at increasing cardiac output and restoring adequate organ perfusion through rapid intravenous administration of a solution. However, this vascular filling can be accompanied by venous congestion, which can be harmful. Fluid administration must therefore be sparing and carefully considered.
However, it is difficult to assess the correct amount of intravenous fluid to inject. Multi-site venous ultrasound (inferior vena cava, suprahepatic vein, portal vein, renal vein), recently published under a score called VExUS, could be a useful bedside tool for documenting venous congestion and avoiding excessive vascular filling. Nevertheless, this tool has been little evaluated in the general intensive care population, particularly in patients with acute respiratory distress syndrome (ARDS). Its link with other venous sites (femoral, popliteal) has also been little studied to date.
The main objective of our study is to describe the distribution of the VEXUS score among patients in a general intensive care unit.
The secondary objectives are:
* To study the feasibility of measuring the VEXUS score in patients with ARDS, including during prone positioning, a recommended and frequently used treatment for this condition, which could make it difficult to acquire venous ultrasound data. * In this case, other more accessible venous flows could be analysed, namely the femoral venous flow and the popliteal venous flow. We will therefore also study their feasibility during prone positioning sessions. * Subsequently, we will study the correspondence between the VEXUS score and these other types of venous flow (femoral, popliteal). * Finally, we will evaluate the association between the VEXUS score in our general intensive care population and the long-term prognosis of patients, in this case death on day 28 and the occurrence of acute renal failure requiring renal replacement therapy during the intensive care stay.
Patients admitted to medical intensive care at Besançon Teaching Hospital for any reason.
Aged over 18.
Affiliated with a French social security scheme or beneficiary of such a scheme.
No objection to participating in the study.
None
Single group
Venous ultrasound (inferior vena cava, portal vein, suprahepatic vein, and renal vein to calculate the VEXUS score ; femoral vein and popliteal vein)
Procedure/SurgeryThe research procedure consists of an abdominal venous ultrasound (inferior vena cava, portal vein, suprahepatic vein and renal vein) to calculate the VEXUS score, and a venous ultrasound of the lower limbs (femoral vein and popliteal vein). This procedure will be performed at the same time as the cardiac ultrasound (using the same equipment), which is a routine examination. This is a non-invasive, non-irradiating examination that has been proven to be safe. There are therefore no risks associated with the research.
Distribution of the VEXUS score among all patients admitted (for any reason) in a general intensive care unit
Describe the distribution of the VEXUS score among all patients admitted (for any reason) in a general intensive care unit at Besançon Teaching Hospital (Besançon, city, FRANCE).
Feasability of VEXUS score measurement in prone position
\- Assess the failure rate of the VEXUS score measurement in prone position (proportion of patients included in whom a VEXUS score value in prone position could not be obtained by the operator in less than 10 minutes).
Feasability of femoral venous flow measurement in supine and prone position
\- Assess the failure rate of femoral venous flow measurement in the supine position and in the prone positioning (proportion of patients included in whom femoral venous flow measurement in the supine position and the prone position could not be obtained by the operator in less than 10 minutes).
Feasability of popliteal venous flow measurement in supine and prone position
\- Assess the failure rate of popliteal venous flow measurement in the supine position and in prone positioning (proportion of patients included in whom popliteal venous flow measurement in the supine position and the prone position could not be obtained by the operator in less than 10 minutes).
VEXUS score evolution before, during and after prone positioning for ARDS
\- Describe the change in the VEXUS score (ranging from 0 (no congestion) to 3 (severe congestion)) before, during, and after the first prone position session in ARDS patients.
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