Early Haemodynamic Optimization Using Preload Dependence During Septic Shock = EHOSS-1
Status:
Completed
Trial end date:
1969-12-31
Target enrollment:
Participant gender:
Summary
Haemodynamic optimization is of paramount importance in septic shock, but is really
consensual and standardized during the first 6 hours of treatment. Haemodynamic treatment
including fluid loading management, vasoactive treatment and oxygen transport optimization is
mainly based on expert recommendations or non-randomized trials. Recently, preload dependence
indexes such as pulse pressure variation have been shown to be more accurate to predict fluid
responsiveness than static indexes such as filling pressures. However, whether using preload
dependence indexes changes septic shock prognostic remains to date unknown. The aim of this
non-blinded randomized controlled trial is to assess whether haemodynamic optimization using
preload dependence indexes and pulmonary thermodilution 1. reduces septic shock duration
assessed by administration duration of vasoactive treatment (primary end point), 2. reduces
regional hypoperfusion assessed by arterial lactate, 3. reduces lung hydrostatic oedema
linked to excessive fluid loading (assessed by PaO2/FIO2 ratio and extravascular lung water).
4. reduces organ dysfunction (assessed by the SOFA score), ICU stay and 7 and 28 day
mortality Control group is managed with an algorithm using filling pressures to drive
haemodynamic treatment.