Bedside ultrasound to guide diuretics in hospitalized acute heart failure
Point-of-Care Ultrasound-Guided Diuresis for Acute Decompensated Heart Failure to Reduce 30-Day Readmissions and Acute Kidney Injury
This project tests whether using bedside ultrasound of the right internal jugular vein to guide IV diuretics helps adults hospitalized with acute decompensated heart failure and low RIJV distensibility avoid excess fluid, kidney injury, and readmission.
Quick facts
| Phase | Not applicable |
|---|---|
| Study type | Interventional |
| Enrollment | 588 (estimated) |
| Ages | 18 Years and up |
| Sex | All |
| Sponsor | University of Pittsburgh Academic / other |
| Locations | 5 sites (Pittsburgh, Pennsylvania and 4 other locations) |
| Trial ID | NCT06921603 on ClinicalTrials.gov |
What this trial studies
Hospitalized adults with acute decompensated heart failure and an RIJV distensibility index below 66% on POCUS are enrolled. Participants receive standard IV furosemide either guided by routine clinical assessment or by serial POCUS measurements of RIJV cross-sectional area and distensibility during rest and Valsalva to estimate right atrial pressure. The POCUS-guided arm uses those measurements to adjust diuretic dosing and duration with the goal of achieving better decongestion at discharge. Outcomes include 30-day readmission, rates of acute kidney injury, and degree of residual congestion at discharge.
Who should consider this trial
Good fit: Adults (age ≥18) hospitalized with acute decompensated heart failure who are planned for IV diuretics and have an RIJV distensibility index <66% on POCUS are ideal candidates.
Not a fit: Patients with LVADs, RIJV or SVC thrombus, significant congenital heart disease, severe tricuspid regurgitation, or those with normal RIJV distensibility are unlikely to benefit from this protocol.
Why it matters
Potential benefit: If successful, this approach could reduce residual fluid at discharge, lower 30-day readmissions, and decrease diuretic-related kidney injury.
How similar studies have performed: Point-of-care ultrasound for bedside volume assessment has shown promise in prior work, but using RIJV distensibility specifically to guide diuresis is relatively novel with limited randomized evidence to date.
Eligibility criteria
Show full inclusion / exclusion criteria
List the inclusion criteria: 1. Age: Patients must be 18 years or older. 2. Diagnosis: Must have a confirmed diagnosis of acute decompensated heart failure (ADHF). 3. Treatment Plan: Patients must be planned for treatment with intravenous (IV) diuretics. 4. POCUS Measurement: Must have an abnormal right internal jugular vein (RIJV) distensibility index (DI) of \<66% on point-of-care ultrasound (POCUS) at the time of admission. These criteria ensure that participants are appropriately selected for the study and are likely to benefit from POCUS-guided diuretic management. List the exclusion criteria: 1. Left Ventricular Assist Devices (LVAD): Patients with LVADs will be excluded due to their unique hemodynamics, which may interfere with study assessments. 2. Anatomical Incompatibilities: Excludes patients with RIJV or superior vena cava thrombus, congenital heart disease, or severe tricuspid regurgitation, as these conditions may impair accurate POCUS measurements. 3. Cardiomyopathy: Patients with hypertrophic or infiltrative cardiomyopathy will be excluded. 4. End-of-Life Care: Patients receiving hospice care or comfort measures only will not be included in the study. 5. Advanced Cancer: Patients with metastatic cancer will be excluded. 6. Severe Liver Dysfunction: Patients with a MELD-Na score greater than 20, indicating severe liver dysfunction, will be excluded. 7. End stage chronic kidney disease 8. Inability to Provide Consent: Patients who are unable to provide informed consent, due to cognitive impairment or other reasons, will not be eligible. 9. Inotropic Support: Patients requiring inotropic support at the time of enrollment will be excluded, as they represent a more severe heart failure profile that may not be suitable for this trial.
Where this trial is running
Pittsburgh, Pennsylvania and 4 other locations
- UPMC East — Pittsburgh, Pennsylvania, United States (Not_yet_recruiting)
- University of Pittsburgh Medical Center — Pittsburgh, Pennsylvania, United States (Recruiting)
- UPMC Presbyterian — Pittsburgh, Pennsylvania, United States (Recruiting)
- UPMC Mercy — Pittsburgh, Pennsylvania, United States (Not_yet_recruiting)
- UPMC Shadyside — Pittsburgh, Pennsylvania, United States (Recruiting)
Study contacts
- Principal investigator: John J Pacella, MD — University of Pittsburgh Medical Center (UPMC)
- Study coordinator: John J Pacella, MD
- Email: pacellajj@upmc.edu
- Phone: 4127805529
How to participate
- Review the eligibility criteria above with your treating physician.
- Visit the official trial page on ClinicalTrials.gov for the most current contact information and recruitment status.
- Contact the listed study coordinator or principal investigator to request pre-screening. Pre-screening is free and never obligates you to enroll.