Right Ventriculo-Arterial Coupling During Fluid Loading in ICU Patients

Recruiting now

Conditions studied: Shock, Right Ventricular Dysfunction, Venous Congestion

In brief

Preload responsiveness and venous congestion have largely been investigated independently in recent literature. However, recent data report a similar incidence of venous congestion regardless of fluid responsiveness status, challenging the concept of a linear continuum between preload independence and fluid intolerance. These findings support the need for a more individualized hemodynamic management strategy that takes venous congestion risk into account. The right ventricle plays a central role in this framework. Its function is to maintain an adequate venous return pressure gradient to ensure cardiac output while limiting upstream venous congestion, under strong dependence on its afterload. In physiological conditions, the right ventricle adapts to changes in afterload by increasing contractility to preserve right ventriculo-arterial coupling and optimize its performance. In chronic cardiopulmonary diseases, right ventriculo-arterial uncoupling is a well-established prognostic factor, including the presence of occult uncoupling revealed by fluid loading. In critically ill patients, right ventricular systolic dysfunction associated with venous congestion-defining right heart failure-is strongly associated with increased mortality, as is right ventriculo-arterial uncoupling itself. To support the concept of fluid tolerance, the investigators hypothesize that impairment of right ventriculo-arterial coupling may exist or occur during fluid loading in critically ill patients, independently of preload responsiveness, and may be associated with worsening upstream venous congestion.

Key facts

Study ID: NCT07537621
Run by: CHU de Reims
People needed: 100
Starts: 2026-06-03
Expected to finish: 2029-06-04
Last updated by the study team: 2026-06-10

Who can join

Age: 18 and older. Sex: any. Healthy volunteers: not accepted.

You may qualify if…

Critically ill hospitalized patients
Age ≥ 18 years
Patients undergoing fluid loading at the discretion of the attending physician, following prediction of fluid responsiveness using any recommended maneuver or dynamic parameter, in the setting of acute circulatory failure requiring vasopressor support and/or mean arterial pressure < 65 mmHg (or a decrease of ≥ 30 mmHg from baseline in patients with chronic hypertension), and/or other signs of hemodynamic instability (tachycardia, mottling, oliguria, hyperlactatemia)
Affiliated with a national health insurance system

You may not qualify if…

Formal refusal from the patient or legally representative after information
Patients transferred from another intensive care unit
Pregnant or postpartum patients
Acute respiratory distress (defined as respiratory rate ≥ 35 breaths/min and/or signs of increased work of breathing)
Ongoing acute coronary syndrome
Acute or pulmonale (defined by right ventricular dilation associated with paradoxical septal motion related to an abrupt increase in right ventricular afterload)
Primary pulmonary arterial hypertension
Intra-abdominal hypertension (intravesical pressure > 15 mmHg)
Poor echogenicity precluding adequate echocardiographic assessment of the right ventricle
Severe valvular heart disease or early postoperative period following valvular surgery

Where it is running

Marie Muller — Reims, France (enrolling)

Full record on ClinicalTrials.gov

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