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Kenny JÉS, Prager R, Rola P, Haycock K, Gibbs SO, Johnston DH, Horner C, Eibl JK, Lau VC, Kemp BO. Simultaneous Venous-Arterial Doppler Ultrasound During Early Fluid Resuscitation to Characterize a Novel Doppler Starling Curve: A Prospective Observational Pilot Study. J Intensive Care Med 2024; 39:628-635. [PMID: 38190576 PMCID: PMC11188059 DOI: 10.1177/08850666231224396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2024]
Abstract
Background: The likelihood of a patient being preload responsive-a state where the cardiac output or stroke volume (SV) increases significantly in response to preload-depends on both cardiac filling and function. This relationship is described by the canonical Frank-Starling curve. Research Question: We hypothesize that a novel method for phenotyping hypoperfused patients (ie, the "Doppler Starling curve") using synchronously measured jugular venous Doppler as a marker of central venous pressure (CVP) and corrected flow time of the carotid artery (ccFT) as a surrogate for SV will refine the pretest probability of preload responsiveness/unresponsiveness. Study Design and Methods: We retrospectively analyzed a prospectively collected convenience sample of hypoperfused adult emergency department (ED) patients. Doppler measurements were obtained before and during a preload challenge using a wireless, wearable Doppler ultrasound system. Based on internal jugular and carotid artery Doppler surrogates of CVP and SV, respectively, we placed hemodynamic assessments into quadrants (Qx) prior to preload augmentation: low CVP with normal SV (Q1), high CVP and normal SV (Q2), low CVP and low SV (Q3) and high CVP and low SV (Q4). The proportion of preload responsive and unresponsive assessments in each quadrant was calculated based on the maximal change in ccFT (ccFTΔ) during either a passive leg raise or rapid fluid challenge. Results: We analyzed 41 patients (68 hemodynamic assessments) between February and April 2021. The prevalence of each phenotype was: 15 (22%) in Q1, 8 (12%) in Q2, 39 (57%) in Q3, and 6 (9%) in Q4. Preload unresponsiveness rates were: Q1, 20%; Q2, 50%; Q3, 33%, and Q4, 67%. Interpretation: Even fluid naïve ED patients with sonographic estimates of low CVP have high rates of fluid unresponsiveness, making dynamic testing valuable to prevent ineffective IVF administration.
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Affiliation(s)
- Jon-Émile S. Kenny
- Health Sciences North Research Institute, Sudbury, ON, Canada
- Flosonics Medical, Sudbury, ON, Canada
| | - Ross Prager
- Division of Critical Care Medicine, Western University, London, ON, Canada
| | - Philippe Rola
- Division of Intensive Care, Santa Cabrini Hospital, Montreal, QC, Canada
| | - Korbin Haycock
- Department of Emergency Medicine, Riverside University Health System Medical Center, Moreno Valley, CA, USA
| | | | | | | | - Joseph K. Eibl
- Health Sciences North Research Institute, Sudbury, ON, Canada
- Flosonics Medical, Sudbury, ON, Canada
- Northern Ontario School of Medicine, Sudbury, ON, Canada
| | - Vivian C. Lau
- Department of Emergency Medicine, OSF Saint Francis Medical Center, Peoria, IL, USA
| | - Benjamin O. Kemp
- Department of Emergency Medicine, OSF Saint Francis Medical Center, Peoria, IL, USA
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Vieillard-Baron A. The role of Inferior Vena Cava in predicting fluid responsiveness. Author's reply. Intensive Care Med 2024:10.1007/s00134-024-07506-4. [PMID: 38884795 DOI: 10.1007/s00134-024-07506-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/29/2024] [Indexed: 06/18/2024]
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Ono S. The role of inferior vena cava in predicting fluid responsiveness. Intensive Care Med 2024:10.1007/s00134-024-07499-0. [PMID: 38842730 DOI: 10.1007/s00134-024-07499-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/22/2024] [Indexed: 06/07/2024]
Affiliation(s)
- Shohei Ono
- Department of Anesthesiology and Critical Care Medicine, Jichi Medical University, Saitama Medical Center, 1-847 Amanuma-cho, Omiya-ku, Saitama-shi, Saitama, 330-8503, Japan.
- Department of Emergency and Critical Care Medicine, Tokyo Metropolitan Tama Medical Center, 2-8-29 Musashidai, Fuchu-shi, Tokyo, 170-8445, Japan.
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Lee MS, Sweetnam-Holmes D, Soffer GP, Harel-Sterling M. Updates on the clinical integration of point-of-care ultrasound in pediatric emergency medicine. Curr Opin Pediatr 2024; 36:256-265. [PMID: 38411588 DOI: 10.1097/mop.0000000000001340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/28/2024]
Abstract
PURPOSE OF REVIEW There is expanding evidence for point-of-care ultrasound (POCUS) use in pediatric emergency medicine - this review highlights the benefits and challenges in the clinical integration of high-yield POCUS applications. Specifically, it will delve into POCUS applications during resuscitations, controversies of Focused Assessment with Sonography for Trauma (FAST) in pediatric trauma, POCUS-guided procedures, and examples of clinical pathways where POCUS can expedite definitive care. RECENT FINDINGS POCUS can enhance diagnostic accuracy and aid in management of pediatric patients in shock and help identify reversible causes during cardiac arrest. The use of the FAST in pediatric blunt abdominal trauma remains nuanced - its proper use requires an integration with clinical findings and an appreciation of its limitations. POCUS has been shown to enhance safety and efficacy of procedures such as nerve blocks, incision & drainage, and intravenous access. Integrating POCUS into pathways for conditions such as intussusception and testicular torsion expedites downstream care. SUMMARY POCUS enhances diagnostic efficiency and management in pediatric patients arriving at the ED with undifferentiated shock, cardiac arrest, or trauma. Additionally, POCUS improves procedural success and safety, and is integral to clinical pathways for expediting definitive care for various pediatric emergencies. Future research should continue to focus on the impact of POCUS on patient outcomes, ensuring user competency, and the expansion of POCUS into diverse settings.
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Affiliation(s)
- Michelle Sin Lee
- Pediatric Emergency Medicine, Hospital for Sick Children, Assistant Professor, University of Toronto, Toronto, ON, Canada
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Rola P, Haycock K, Spiegel R. What every intensivist should know about the IVC. J Crit Care 2024; 80:154455. [PMID: 37945462 DOI: 10.1016/j.jcrc.2023.154455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Revised: 05/02/2023] [Accepted: 05/05/2023] [Indexed: 11/12/2023]
Abstract
Assessment of the IVC by point-of-care ultrasound in the context of resuscitation has been a controversial topic in the last decades. Most of the focus had been on its use as a surrogate marker for fluid responsiveness, with results being equivocal. We review its important anatomical aspects as well as the physiological rationale behind ultrasound assessment and propose a new way to do so, as well as explain its central role in the concept of fluid tolerance.
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Affiliation(s)
- Philippe Rola
- Intensive Care Unit, Santa Cabrini Hospital, CEMTL, Montreal, Canada.
| | - Korbin Haycock
- Emergency Department, Riverside University Health Systems, Moreno Valley, CA, Loma Linda University Medical Center, Loma Linda CA, and Desert Regional Medical Center, Palm Springs, CA, United States of America
| | - Rory Spiegel
- Departments of Critical Care and Emergency Medicine, Medstar Washington Hospital Center, Washington, DC, United States of America
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Inci K, Gürsel G. Accuracy of Pocket-sized Ultrasound Devices to Evaluate Inferior Vena Cava Diameter and Variability in Critically Ill Patients. Indian J Crit Care Med 2024; 28:369-374. [PMID: 38585318 PMCID: PMC10998516 DOI: 10.5005/jp-journals-10071-24674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 02/14/2024] [Indexed: 04/09/2024] Open
Abstract
Purpose By using inferior vena cava (IVC) measurements, clinicians can detect fluid status and responsiveness and find out the etiology of hypotension, acute heart failure, and sepsis easier. Pocket-sized ultrasound devices (PSUD) may take this advantage a few steps further by their lower costs, user-friendly interface, and easily applicable structure.In this study, we aimed to determine the diagnostic value of a PSUD compared with a standard ultrasound device (SD) for the measurement of IVC diameter (IVCD) and its respiratory variability. Materials and methods We measured the inspiratory, expiratory diameters of IVC, and calculated the inferior vena cava collapsibility index (IVCCI). We investigated 42 intensive care unit (ICU) patients. Results There was no difference in inspiratory (PSUD: 1.34 ± 0.67 cm; SD: 1.35 ± 0.68 cm) and expiratory (PSUD: 1.98 ± 0.53 cm; SD: 2.01 ± 0.49 cm) IVCD among measurements with PSUD and SD (p > 0.05). There was also no difference between IVCCI's measured with PSUD (39 ± 20%) and SD (39 ± 20%) (p > 0.05). The Bland-Altman analysis revealed that the width of 95% limits of agreement were similar for both devices. There was a good inter-device agreement among PSUD and SD for measurements of IVCD, and there was no difference between IVCCI's measured using both ultrasound devices. Conclusion We support that the idea of a PSUD is as reliable as a SD for IVC measurements. How to cite this article Inci K, Gürsel G. Accuracy of Pocket-sized Ultrasound Devices to Evaluate Inferior Vena Cava Diameter and Variability in Critically Ill Patients. Indian J Crit Care Med 2024;28(4):369-374.
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Affiliation(s)
- Kamil Inci
- Faculty of Medicine, Department of Internal Medicine, Division of Critical Care, Gazi University, Ankara, Turkey
| | - Gül Gürsel
- Faculty of Medicine, Department of Pulmonary Critical Care Medicine, Gazi University, Ankara, Turkey
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Deschamps J, Beaubien-Souligny W. Venous Doppler for Echocardiographic Right Atrial Pressure Estimation: Ready for Primetime? Chest 2024; 165:478-481. [PMID: 38461005 DOI: 10.1016/j.chest.2023.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Accepted: 11/06/2023] [Indexed: 03/11/2024] Open
Affiliation(s)
- Jean Deschamps
- Department of Intensive Care Medicine, Integrated Hospital Care Institute, Cleveland Clinic, Cleveland, OH.
| | - William Beaubien-Souligny
- Division of Nephrology, Centre Hospitalier de l'Université de Montréal, Innovation Hub, Centre de Recherche du CHUM, Montréal, QC, Canada
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Bellini T, Chianucci B, D'Alessandro M, Ricci M, Calevo MG, Misley S, Piccotti E, Moscatelli A. The usefulness of point-of-care ultrasound in dehydrated patients in a pediatric emergency department. Ultrasound J 2024; 16:13. [PMID: 38383828 PMCID: PMC10881941 DOI: 10.1186/s13089-023-00354-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 12/16/2023] [Indexed: 02/23/2024] Open
Abstract
BACKGROUNDS Dehydration is among the most common causes of Pediatric Emergency Department admission; however, no clinical signs, symptoms, or biomarkers have demonstrated sufficient sensitivity, specificity, or reliability to predict dehydration. METHODS We conducted a prospective, monocentric, observational study at Giannina Gaslini Hospital, a tertiary care pediatric hospital. Our study aimed to compare inferior vena cava ultrasound measurement with volume depletion biomarkers to understand if point-of-care ultrasound could help grade, evaluate, and better manage dehydration in children presenting to the pediatric emergency department. We enrolled patients under the age of 14 who required blood tests in the suspect of dehydration; for each patient, we collected values of venous pH, natremia, bicarbonatemia, uric acid, chloremia, and blood urea nitrogen. For each patient, we performed two ultrasound scans to calculate the Inferior Vena Cava/Aorta area ratio and to assess the IVC collapsibility index; moreover, we described the presence of the "kiss sign" (100% IVC walls collapsing during the inspiratory phase). RESULTS Patients with the "kiss sign" (25/65 patients, 38.5% of the total) showed worse blood tests, in particular, uric acid levels (p = 0.0003), bicarbonatemia (p = 0.001) and natriemia (p = 0.0003). Moreover, patients with the "kiss sign" showed a high frequency of ≥ 2 pathological blood tests (p = 0.0002). We found no statistical significant difference when comparing the IVC/Ao ratio and IVC-CI with the considered blood tests. CONCLUSIONS The "kiss sign" seems to be related to worse hydration state, whereas IVC/Ao and IVC-CI are not. In an emergency setting, where physicians must take diagnostic-therapeutic decisions quickly, the presence of the "kiss sign" in patients suspected to be dehydrated can be a helpful tool in their management.
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Affiliation(s)
- Tommaso Bellini
- Pediatric Emergency Room and Emergency Medicine Unit, Emergency Department, IRCCS Istituto Giannina Gaslini, Via G. Gaslini 5, 16147, Genoa, Italy
| | - Benedetta Chianucci
- Pediatric Emergency Room and Emergency Medicine Unit, Emergency Department, IRCCS Istituto Giannina Gaslini, Via G. Gaslini 5, 16147, Genoa, Italy
| | - Matteo D'Alessandro
- Pediatric Emergency Room and Emergency Medicine Unit, Emergency Department, IRCCS Istituto Giannina Gaslini, Via G. Gaslini 5, 16147, Genoa, Italy.
| | - Margherita Ricci
- Pediatric and Neonatology Unit, San Paolo Hospital (Savona), IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Maria Grazia Calevo
- Epidemiology and Biostatistics Unit, Scientific Directorate IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Silvia Misley
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy
| | - Emanuela Piccotti
- Pediatric Emergency Room and Emergency Medicine Unit, Emergency Department, IRCCS Istituto Giannina Gaslini, Via G. Gaslini 5, 16147, Genoa, Italy
| | - Andrea Moscatelli
- Neonatal and Pediatric Intensive Care Unit, Emergency Department, IRCCS Istituto Giannina Gaslini, Genoa, Italy
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Grotberg JC, McDonald RK, Co IN. Point-of-Care Echocardiography in the Difficult-to-Image Patient in the ICU: A Narrative Review. Crit Care Explor 2024; 6:e1035. [PMID: 38222871 PMCID: PMC10786596 DOI: 10.1097/cce.0000000000001035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2024] Open
Abstract
OBJECTIVES The objective of this narrative review was to address common obstacles encountered in the ICU to acquiring quality and interpretable images using point-of-care echocardiography. DATA SOURCES Detailed searches were performed using PubMed and Ovid Medline using medical subject headings and keywords on topics related to patient positioning, IV echo contrast, alternative subcostal views, right ventricular outflow tract (RVOT) hemodynamics, and point-of-care transesophageal echocardiography. Articles known to the authors were also selected based on expert opinion. STUDY SELECTION Articles specific to patient positioning, IV echo contrast, alternative subcostal views, RVOT hemodynamics, and point-of-care transesophageal echocardiography were considered. DATA EXTRACTION One author screened titles and extracted relevant data while two separate authors independently reviewed selected articles. DATA SYNTHESIS Impediments to acquiring quality and interpretable images in critically ill patients are common. Notably, body habitus, intra-abdominal hypertension, dressings or drainage tubes, postoperative sternotomies, invasive mechanical ventilation, and the presence of subcutaneous emphysema or lung hyperinflation are commonly encountered obstacles in transthoracic image acquisition in the ICU. Despite these obstacles, the bedside clinician may use obstacle-specific maneuvers to enhance image acquisition. These may include altering patient positioning, respiratory cycle timing, expanding the subcostal window to include multilevel short-axis views for use in the assessment of RV systolic function and hemodynamics, coronal transhepatic view of the inferior vena cava, and finally point-of-care transesophageal echocardiography. CONCLUSIONS Despite common obstacles to point-of-care echocardiography in critically ill patients, the beside sonographer may take an obstacle-specific stepwise approach to enhance image acquisition in difficult-to-image patients.
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Affiliation(s)
- John C Grotberg
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Washington University School of Medicine, Saint Louis, MO
| | - Rachel K McDonald
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Washington University School of Medicine, Saint Louis, MO
| | - Ivan N Co
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Michigan, Ann Arbor, MI
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Kaptein EM, Kaptein MJ. Inferior vena cava ultrasound and other techniques for assessment of intravascular and extravascular volume: an update. Clin Kidney J 2023; 16:1861-1877. [PMID: 37915939 PMCID: PMC10616489 DOI: 10.1093/ckj/sfad156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Indexed: 11/03/2023] Open
Abstract
Goals of volume management are to accurately assess intravascular and extravascular volume and predict response to volume administration, vasopressor support or volume removal. Data are reviewed that support the following: (i) Dynamic parameters reliably guide volume administration and may improve clinical outcomes compared with static parameters, but some are invasive or only validated with mechanical ventilation without spontaneous breathing. (ii) Ultrasound visualization of inferior vena cava (IVC) diameter variations with respiration reliably assesses intravascular volume and predicts volume responsiveness. (iii) Although physiology of IVC respiratory variations differs with mechanical ventilation and spontaneous breathing, the IVC collapsibility index (CI) and distensibility index are interconvertible. (iv) Prediction of volume responsiveness by IVC CI is comparable for mechanical ventilation and spontaneous breathing patients. (v) Respiratory variations of subclavian/proximal axillary and internal jugular veins by ultrasound are alternative sites, with comparable reliability. (vi) Data support clinical applicability of IVC CI to predict hypotension with anesthesia, guide ultrafiltration goals, predict dry weight, predict intra-dialytic hypotension and assess acute decompensated heart failure. (vii) IVC ultrasound may complement ultrasound of heart and lungs, and abdominal organs for venous congestion, for assessing and managing volume overload and deresuscitation, renal failure and shock. (viii) IVC ultrasound has limitations including inadequate visualization. Ultrasound data should always be interpreted in clinical context. Additional studies are required to further assess and validate the role of bedside ultrasonography in clinical care.
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Affiliation(s)
- Elaine M Kaptein
- Departments of Medicine, Divisions of Nephrology, University of Southern California, Los Angeles, CA, USA
| | - Matthew J Kaptein
- Departments of Medicine, Divisions of Nephrology, University of Southern California, Los Angeles, CA, USA
- Loma Linda University Medical Center, Loma Linda, CA, USA
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Dunfield R, Ross P, Dutton D, Chandra K, Lewis D, Scheuermeyer F, Fraser J, Boreskie P, Pham C, Ali S, Lamprecht H, Stander M, Keyes C, Henneberry R, Atkinson P. SHoC-IVC: Does assessment of the inferior vena cava by point-of-care ultrasound independently predict fluid status in spontaneously breathing patients with undifferentiated hypotension? CAN J EMERG MED 2023; 25:902-908. [PMID: 37755657 DOI: 10.1007/s43678-023-00584-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 08/17/2023] [Indexed: 09/28/2023]
Abstract
BACKGROUND Accurately determining the fluid status of a patient during resuscitation in the emergency department (ED) helps guide appropriate fluid administration in the setting of undifferentiated hypotension. Our goal was to determine the diagnostic utility of point-of-care ultrasound (PoCUS) for inferior vena cava (IVC) size and collapsibility in predicting a volume overload fluid status in spontaneously breathing hypotensive ED patients. METHODS This was a post hoc secondary analysis of the SHOC-ED data, a prospective randomized controlled trial investigating PoCUS in patients with undifferentiated hypotension. We prospectively collected data on IVC size and collapsibility for 138 patients in the PoCUS group using a standard data collection form, and independently assigned a fluid status (volume overloaded, normal, volume deplete) from a composite clinical chart review blinded to PoCUS findings. The primary outcome was the diagnostic performance of IVC characteristics on PoCUS in the detection of a volume overloaded fluid status. RESULTS One hundred twenty-nine patients had completed determinant IVC assessment by PoCUS, with one hundred twenty-five receiving successful final fluid status determination, of which one hundred and seven were classified as volume deplete, thirteen normal, and seven volume overloaded. A receiver operating characteristic (ROC) curve was plotted using several IVC size and collapsibility categories. The best overall performance utilized the combined parameters of a dilated IVC (> 2.5 cm) with minimal collapsibility (less than 50%) which had a sensitivity of 85.7% and specificity of 86.4% with an area under the curve (AOC) of 0.92 for predicting an volume overloaded fluid status. CONCLUSION IVC PoCUS is feasible in spontaneously breathing hypotensive adult ED patients, and demonstrates potential value as a predictor of a volume overloaded fluid status in patients with undifferentiated hypotension. IVC size may be the preferred measure.
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Affiliation(s)
- Robert Dunfield
- Department of Emergency Medicine, Dalhousie Medicine New Brunswick, Horizon Health Network, Saint John, NB, Canada
| | - Peter Ross
- Department of Emergency Medicine, Dalhousie Medicine New Brunswick, Horizon Health Network, Saint John, NB, Canada
| | - Daniel Dutton
- Department of Emergency Medicine, Dalhousie Medicine New Brunswick, Horizon Health Network, Saint John, NB, Canada
| | - Kavish Chandra
- Department of Emergency Medicine, Dalhousie Medicine New Brunswick, Horizon Health Network, Saint John, NB, Canada
| | - David Lewis
- Department of Emergency Medicine, Dalhousie Medicine New Brunswick, Horizon Health Network, Saint John, NB, Canada
| | - Frank Scheuermeyer
- Department of Emergency Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Jacqueline Fraser
- Department of Emergency Medicine, Horizon Health Network, Saint John, NB, Canada
| | - Patrick Boreskie
- Department of Emergency Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Chau Pham
- Department of Emergency Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Sultan Ali
- Department of Emergency Medicine, Dalhousie Medicine New Brunswick, Horizon Health Network, Saint John, NB, Canada
| | - Hein Lamprecht
- Division of Emergency Medicine, University of Stellenbosch, Cape Town, South Africa
| | - Melanie Stander
- Division of Emergency Medicine, University of Stellenbosch, Cape Town, South Africa
| | - Cameron Keyes
- St. Francis Xavier University, Antigonish, NS, Canada
| | - Ryan Henneberry
- Department of Emergency Medicine, Dalhousie University, Halifax, NS, Canada
| | - Paul Atkinson
- Department of Emergency Medicine, Dalhousie Medicine New Brunswick, Horizon Health Network, Saint John, NB, Canada.
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Hrabovsky V, Skrobankova M, Lys Z, Vrtkova A, Spacilova V, Vaclavik J. Point-of-care ultrasound (POCUS) in acute hospitalized older patients focused on hydration. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2023. [PMID: 37799003 DOI: 10.5507/bp.2023.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/07/2023] Open
Abstract
BACKGROUND Acutely ill older patients frequently suffer not only from their acute disease, but also polymorbidity and frailty. Dehydration is another typical symptom, usually occurring in its both forms: low-intake dehydration and volume depletion. POCUS is goal-directed bedside ultrasound examination and several studies refer to its positive impact on hydration assessment. The aim of our study was to determine whether POCUS might influence (de)hydration diagnostics and/or treatments in older patients with acute illness. METHODS We randomized 120 acutely ill patients, aged ≥65 years, into POCUS and non-POCUS groups. All participants underwent routine laboratory tests, including haematocrit, serum and urine osmolality, blood urea nitrogen (BUN), creatinine, BUN/creatinine ratio, and C-reactive protein (CRP). POCUS was performed twice during the first two days to determine chest and abdominal status, with inferior vena cava (IVC) measurements. Length of hospital stay (HL) and consumption of infused fluids (CIF) was evaluated too. Data were analysed with exploratory methods and appropriate statistics. RESULTS Among all participants, the serum osmolality significantly correlated with age, BUN, creatinine and CIF. HL correlated with CRP and CIF. No significant correlations between IVC and other followed parameters were found. The POCUS group consumed significantly less infused fluids than the non-POCUS group, what could be influenced by POCUS examination of defined body compartments. CONCLUSION Dehydration is a common feature in older individuals and its diagnostics is rather complicated. The role of POCUS in assessing hydration status remains unclear. However, our study showed, that ultrasound assessment provides next important information for comprehensive understanding of clinical status in older patients and can be beneficial for optimizing the treatment strategy, including fluid management decisions.
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Affiliation(s)
- Vladimir Hrabovsky
- Department of Internal Medicine, University Hospital Ostrava, Czech Republic
- Faculty of Medicine, University of Ostrava, Czech Republic
| | - Martina Skrobankova
- Department of Internal Medicine, University Hospital Ostrava, Czech Republic
- Faculty of Medicine, University of Ostrava, Czech Republic
| | - Zdenek Lys
- Department of Internal Medicine, University Hospital Ostrava, Czech Republic
- Faculty of Medicine, University of Ostrava, Czech Republic
| | - Adela Vrtkova
- Department of Deputy Director of Science and Research, University Hospital Ostrava, Ostrava, Czech Republic
- Department of Applied Mathematics, Faculty of Electrical Engineering and Computer Science, VSB - Technical University of Ostrava, Czech Republic
| | - Veronika Spacilova
- Department of Internal Medicine, University Hospital Ostrava, Czech Republic
- Faculty of Medicine, University of Ostrava, Czech Republic
| | - Jan Vaclavik
- Department of Internal Medicine, University Hospital Ostrava, Czech Republic
- Faculty of Medicine, University of Ostrava, Czech Republic
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Kaminecki I, Huang DM, Shipman PC, Gibson RW. Point-of-Care Ultrasonography for the Assessment of Dehydration in Children: A Systematic Review. Pediatr Emerg Care 2023; 39:786-796. [PMID: 37562138 DOI: 10.1097/pec.0000000000003025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/12/2023]
Abstract
OBJECTIVES Accurate estimation of the degree of dehydration remains a diagnostic challenge. The primary objective was to systematically review the literature on the role of ultrasound in assessment of the degree of dehydration in children. METHODS Data sources included Ovid MEDLINE, Web of Science Core Collection, Current Index to Nursing and Allied Health Literature, Cochrane Library, ClinicalTrials.gov , and Trip Pro Database. Two independent reviewers used screening protocol to include articles on assessment of dehydration in children with the use of point-of-care ultrasonography (POCUS). The level of evidence was assessed in accordance with the "The Oxford 2011 Levels of Evidence." The Quality Assessment of Diagnostic Accuracy Studies-2 tool was used to evaluate risk of bias. RESULTS We identified 108 studies, and 8 studies met our inclusion criteria. All studies were prospective cohort studies (level of evidence, 3-4). The authors of 5 studies used difference between ill weight and weight after rehydration as the reference standard for dehydration, and the authors of 3 studies used clinical dehydration scale. Two studies from the United States showed acceptable areas under the curve for inferior vena cava to aorta (IVC/Ao) diameter ratio at 0.72 and 0.73 for prediction of significant dehydration (>5% weight loss). The IVC/Ao ratio with cut-off at 0.8 had sensitivity of 67% and 86% and specificity of 71% and 56% for prediction of significant dehydration. Studies from the resource-limited settings were more heterogeneous. One study with acceptable risk of biases reported poor sensitivity (67%) and specificity (49%) of Ao/IVC ratio with cut-off of 2.0 for predicting severe dehydration (>9% weight loss) with area under the curve at 0.6. Three studies showed increase in IVC diameter with fluid resuscitation with mean change in IVC diameter by 30% in children with significant dehydration (>5% weight loss) and by 22% without significant dehydration (<5% weight loss). Metaanalysis was not completed due to high heterogeneity. CONCLUSIONS This study showed that the quantity and quality of research on the application of POCUS for the assessment of dehydration in children is limited. There is no criterion standard for assessing the degree of dehydration and no universal definition of the degree of dehydration. Thus, more methodologically rigorous studies are required. Current systematic review does not support the routine use of US to determine the severity of dehydration in children. Despite these limitations, the use of POCUS in children with dehydration demonstrates potential. Given the clear increase in IVC size with rehydration, repeated IVC US scans may be helpful in guiding fluid resuscitation in children with dehydration. From different proposed US parameters, IVC/Ao ratio has better diagnostic accuracy in detecting significant dehydration than Ao/IVC ratio and IVC collapsibility index. Despite low to moderate diagnostic performance, US still showed better assessment of dehydration than physician gestalt and World Health Organization score.
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Teixeira JP, Zeidman A, Beaubien-Souligny W, Cerdá J, Connor MJ, Eggleston K, Juncos LA, da Silva JR, Wells C, Yessayan L, Barker AB, McConville W, Speer R, Wille KM, Neyra JA, Tolwani A. Proceedings of the 2022 UAB CRRT Academy: Non-Invasive Hemodynamic Monitoring to Guide Fluid Removal with CRRT and Proliferation of Extracorporeal Blood Purification Devices. Blood Purif 2023; 52:857-879. [PMID: 37742622 DOI: 10.1159/000533573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 06/29/2023] [Indexed: 09/26/2023]
Abstract
In 2022, we celebrated the 15th anniversary of the University of Alabama at Birmingham (UAB) Continuous Renal Replacement Therapy (CRRT) Academy, a 2-day conference attended yearly by an international audience of over 100 nephrology, critical care, and multidisciplinary trainees and practitioners. This year, we introduce the proceedings of the UAB CRRT Academy, a yearly review of select emerging topics in the field of critical care nephrology that feature prominently in the conference. First, we review the rapidly evolving field of non-invasive hemodynamic monitoring and its potential to guide fluid removal by renal replacement therapy (RRT). We begin by summarizing the accumulating data associating fluid overload with harm in critical illness and the potential for harm from end-organ hypoperfusion caused by excessive fluid removal with RRT, underscoring the importance of accurate, dynamic assessment of volume status. We describe four applications of point-of-care ultrasound used to identify patients in need of urgent fluid removal or likely to tolerate fluid removal: lung ultrasound, inferior vena cava ultrasound, venous excess ultrasonography, and Doppler of the left ventricular outflow track to estimate stroke volume. We briefly introduce other minimally invasive hemodynamic monitoring technologies before concluding that additional prospective data are urgently needed to adapt these technologies to the specific task of fluid removal by RRT and to learn how best to integrate them into practical fluid-management strategies. Second, we focus on the growth of novel extracorporeal blood purification devices, starting with brief reviews of the inflammatory underpinnings of multiorgan dysfunction and the specific applications of pathogen, endotoxin, and/or cytokine removal and immunomodulation. Finally, we review a series of specific adsorptive technologies, several of which have seen substantial clinical use during the COVID-19 pandemic, describing their mechanisms of target removal, the limited existing data supporting their efficacy, ongoing and future studies, and the need for additional prospective trials.
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Affiliation(s)
- J Pedro Teixeira
- Division of Nephrology and Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Internal Medicine, University of New Mexico, Albuquerque, New Mexico, USA
| | - Amanda Zeidman
- Division of Nephrology, Department of Medicine, Institute for Critical Care Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | | | - Jorge Cerdá
- Department of Medicine, Nephrology, Albany Medical College, Albany, New York, USA
| | - Michael J Connor
- Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine and Division of Renal Medicine, Department of Medicine, Emory University, Atlanta, Georgia, USA
| | | | - Luis A Juncos
- Division of Nephrology, Department of Internal Medicine, Central Arkansas Veterans' Healthcare System, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | | | - Catherine Wells
- Division of Nephrology, Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Lenar Yessayan
- Division of Nephrology, Department of Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Andrew B Barker
- Division of Critical Care Medicine, Department of Anesthesiology and Perioperative Medicine, University of Alabama Birmingham, Birmingham, Alabama, USA
| | - Wendy McConville
- School of Nursing, University of Alabama Birmingham, Birmingham, Alabama, USA
| | - Rajesh Speer
- Division of Nephrology, Department of Medicine, University of Alabama Birmingham, Birmingham, Alabama, USA
| | - Keith M Wille
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, University of Alabama Birmingham, Birmingham, Alabama, USA
| | - Javier A Neyra
- Division of Nephrology, Department of Medicine, University of Alabama Birmingham, Birmingham, Alabama, USA
| | - Ashita Tolwani
- Division of Nephrology, Department of Medicine, University of Alabama Birmingham, Birmingham, Alabama, USA
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15
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Rajajee V, Soroushmehr R, Williamson CA, Najarian K, Ward K, Tiba H. Transcranial Color-Coded Sonography With Angle Correction As a Screening Tool for Raised Intracranial Pressure. Crit Care Explor 2023; 5:e0953. [PMID: 37644975 PMCID: PMC10461938 DOI: 10.1097/cce.0000000000000953] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/31/2023] Open
Abstract
OBJECTIVES Transcranial Doppler (TCD) has been evaluated as a noninvasive intracranial pressure (ICP) assessment tool. Correction for insonation angle, a potential source of error, with transcranial color-coded sonography (TCCS) has not previously been reported while evaluating ICP with TCD. Our objective was to study the accuracy of TCCS for detection of ICP elevation, with and without the use of angle correction. DESIGN Prospective study of diagnostic accuracy. SETTING Academic neurocritical care unit. PATIENTS Consecutive adults with invasive ICP monitors. INTERVENTIONS Ultrasound assessment with TCCS. MEASUREMENTS AND MAIN RESULTS End-diastolic velocity (EDV), time-averaged peak velocity (TAPV), and pulsatility index (PI) were measured in the bilateral middle cerebral arteries with and without angle correction. Concomitant mean arterial pressure (MAP) and ICP were recorded. Estimated cerebral perfusion pressure (CPP) was calculated as estimated CPP (CPPe) = MAP × (EDV/TAPV) + 14, and estimated ICP (ICPe) = MAP-CPPe. Sixty patients were enrolled and 55 underwent TCCS. Receiver operating characteristic curve analysis of ICPe for detection of invasive ICP greater than 22 mm Hg revealed area under the curve (AUC) 0.51 (0.37-0.64) without angle correction and 0.73 (0.58-0.84) with angle correction. The optimal threshold without angle correction was ICPe greater than 18 mm Hg with sensitivity 71% (29-96%) and specificity 28% (16-43%). With angle correction, the optimal threshold was ICPe greater than 21 mm Hg with sensitivity 100% (54-100%) and specificity 30% (17-46%). The AUC for PI was 0.61 (0.47-0.74) without angle correction and 0.70 (0.55-0.92) with angle correction. CONCLUSIONS Angle correction improved the accuracy of TCCS for detection of elevated ICP. Sensitivity was high, as appropriate for a screening tool, but specificity remained low.
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Affiliation(s)
- Venkatakrishna Rajajee
- Department of Neurosurgery, University of Michigan, Ann Arbor, MI
- Department of Neurology, University of Michigan, Ann Arbor, MI
- Max Harry Weil Institute for Critical Care Research and Innovation, University of Michigan, Ann Arbor, MI
| | - Reza Soroushmehr
- Max Harry Weil Institute for Critical Care Research and Innovation, University of Michigan, Ann Arbor, MI
- Department of Emergency Medicine, University of Michigan, Ann Arbor, MI
- Department of Computational Medicine & Bioinformatics, University of Michigan, Ann Arbor, MI
| | - Craig A Williamson
- Department of Neurosurgery, University of Michigan, Ann Arbor, MI
- Department of Neurology, University of Michigan, Ann Arbor, MI
- Max Harry Weil Institute for Critical Care Research and Innovation, University of Michigan, Ann Arbor, MI
| | - Kayvan Najarian
- Max Harry Weil Institute for Critical Care Research and Innovation, University of Michigan, Ann Arbor, MI
- Department of Emergency Medicine, University of Michigan, Ann Arbor, MI
- Department of Computational Medicine & Bioinformatics, University of Michigan, Ann Arbor, MI
- Department of Electrical Engineering, University of Michigan, Ann Arbor, MI
| | - Kevin Ward
- Max Harry Weil Institute for Critical Care Research and Innovation, University of Michigan, Ann Arbor, MI
- Department of Emergency Medicine, University of Michigan, Ann Arbor, MI
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI
| | - Hakam Tiba
- Max Harry Weil Institute for Critical Care Research and Innovation, University of Michigan, Ann Arbor, MI
- Department of Emergency Medicine, University of Michigan, Ann Arbor, MI
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16
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Vaidya GN, Kolodziej A, Stoner B, Galaviz JV, Cao X, Heier K, Thompson M, Birks E, Campbell K. Bedside ultrasound of the internal jugular vein to assess fluid status and right ventricular function: The POCUS-JVD study. Am J Emerg Med 2023; 70:151-156. [PMID: 37307660 DOI: 10.1016/j.ajem.2023.05.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 05/08/2023] [Accepted: 05/28/2023] [Indexed: 06/14/2023] Open
Abstract
BACKGROUND Accurate estimation of fluid status is important in the management of heart failure patients, however, the current methods for bedside assessment can be unreliable or impractical for daily use. METHODS Non-ventilated patients were enrolled immediately prior to scheduled right heart catheterization (RHC). Using M-mode, IJV maximum (Dmax) and minimum (Dmin) anteroposterior diameters were measured during normal breathing, while supine. Respiratory variation in diameter (RVD) was calculated as [(Dmax - Dmin)/Dmax] in percentage. Collapsibility with sniff maneuver (COS) was assessed. Lastly, inferior vena cava (IVC) was assessed. Pulmonary artery pulsatility index (PAPi) was calculated. Data was obtained by five investigators. RESULTS Total 176 patients were enrolled. Mean BMI was 30.5 kg/m2, LVEF 14-69% (range), 38% with LVEF ≤35%. The POCUS of IJV could be performed in all patients in <5 min. Increasing RAP demonstrated progressive increase in IJV and IVC diameters. For high filling pressure (RAP ≥10 mmHg), an IJV Dmax ≥1.2 cm or IJV-RVD < 30% had specificity >70%. Combining the POCUS of IJV to physical examination improved the combined specificity to 97% for RAP ≥10 mmHg. Conversely, a finding of IJV-COS was 88% specific for normal RAP (<10 mmHg). An IJV-RVD <15% is suggested as a cutoff for RAP ≥15 mmHg. The performance of IJV POCUS was comparable to IVC. For RV function assessment, IJV-RVD < 30% had 76% sensitivity and 73% specificity for PAPi <3, while IJV-COS was 80% specific for PAPi ≥3. CONCLUSION POCUS of IJV is an easy to perform, specific and reliable method for volume status estimation in daily practice. An IJV-RVD < 30% is suggested for estimation of RAP ≥10 mmHg and PAPi <3.
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Affiliation(s)
- Gaurang Nandkishor Vaidya
- Division of Cardiovascular Medicine, University of Kentucky, Lexington, KY, United States of America; Cardiac Amyloidosis Program, University of Kentucky, Lexington, KY, United States of America.
| | - Andrew Kolodziej
- Division of Cardiovascular Medicine, University of Kentucky, Lexington, KY, United States of America
| | - Benjamin Stoner
- Division of Cardiovascular Medicine, University of Kentucky, Lexington, KY, United States of America
| | - Josue Villegas Galaviz
- Division of Cardiovascular Medicine, University of Kentucky, Lexington, KY, United States of America
| | - Xiangkun Cao
- Division of Cardiovascular Medicine, University of Kentucky, Lexington, KY, United States of America
| | - Kory Heier
- Department of Biostatistics, University of Kentucky, Lexington, KY, United States of America
| | - Mindy Thompson
- Division of Cardiovascular Medicine, University of Kentucky, Lexington, KY, United States of America
| | - Emma Birks
- Division of Cardiovascular Medicine, University of Kentucky, Lexington, KY, United States of America
| | - Kenneth Campbell
- Division of Cardiovascular Medicine, University of Kentucky, Lexington, KY, United States of America
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17
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Sarıhan A, Güllüpinar B, Sağlam C, Karagöz A, Tandon S, Turhan A, Koran S, Ünlüer EE. Comparison of tricuspid and mitral annular plane systolic excursion in determination of acute blood loss in healthy volunteers. Intern Emerg Med 2023; 18:1543-1550. [PMID: 36929348 DOI: 10.1007/s11739-023-03246-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 02/22/2023] [Indexed: 03/18/2023]
Abstract
Ultrasound is used more and more in determining acute blood loss. This study is to compare tricuspid annular plane systolic excursion (TAPSE) and mitral annular plane systolic excursion (MAPSE) measurement to determine volume loss pre and post blood donation in healthy volunteers. The systolic, diastolic and mean arterial blood pressures and pulses of the donors were measured in the standing and supine position by the attending physician, then, inferior vena cava (IVC), TAPSE and MAPSE measurements were made pre and post blood donation. Statistically significant differences were found in systolic blood pressure and pulse rate values that obtained in the standing position, and in the systolic blood pressure, diastolic blood pressure, mean arterial pressure and pulse values that obtained in the supine position (p < 0.05). The difference between IVC expiration (IVCexp) pre and post blood donation was 4.76 ± 2.94 mm, and the difference in IVC inspiration (IVCins) was 2.73 ± 2.91 mm. In addition, the MAPSE and TAPSE differences were 2.16 ± 1.4 mm and 2.98 ± 2.13 mm, respectively. Statistically significant differences were found between IVCins-exp, TAPSE and MAPSE values. TAPSE and MAPSE can be helpful in the early diagnosis of acute blood loss.
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Affiliation(s)
- Aydın Sarıhan
- Department of Emergency Medicine, Merkezefendi State Hospital, 45110, Manisa, Turkey.
| | - Birdal Güllüpinar
- Department of Emergency Izmir, Bozyaka Training and Research Hospital, 35122, İzmir, Turkey
| | - Caner Sağlam
- Department of Emergency Izmir, Bozyaka Training and Research Hospital, 35122, İzmir, Turkey
| | - Arif Karagöz
- Department of Emergency, Izmir Çiğli Training Hospital, 35550, İzmir, Turkey
| | - Shikha Tandon
- Parexel International Ltd., Chandigarh, 133301, India
| | - Ajda Turhan
- Ege University Blood Bank, 34014, İzmir, Turkey
| | - Serhat Koran
- Department of Family Medicine, Medipol University Hospital, 34815, Istanbul, Turkey
| | - Erden Erol Ünlüer
- Department of Emergency Izmir, Bozyaka Training and Research Hospital, 35122, İzmir, Turkey
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18
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Hung KC, Huang YT, Tsai WW, Tan PH, Wu JY, Huang PY, Liu TH, Chen IW, Sun CK. Diagnostic Efficacy of Carotid Ultrasound for Predicting the Risk of Perioperative Hypotension or Fluid Responsiveness: A Meta-Analysis. Diagnostics (Basel) 2023; 13:2290. [PMID: 37443683 DOI: 10.3390/diagnostics13132290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 06/28/2023] [Accepted: 07/03/2023] [Indexed: 07/15/2023] Open
Abstract
Despite the acceptance of carotid ultrasound for predicting patients' fluid responsiveness in critical care and anesthesia, its efficacy for predicting hypotension and fluid responsiveness remains unclear in the perioperative setting. Electronic databases were searched from inception to May 2023 to identify observational studies focusing on the use of corrected blood flow time (FTc) and respirophasic variation in carotid artery blood flow peak velocity (ΔVpeak) for assessing the risks of hypotension and fluid responsiveness. Using FTc as a predictive tool (four studies), the analysis yielded a pooled sensitivity of 0.82 (95% confidence interval (CI): 0.72 to 0.89) and specificity of 0.94 (95% CI: 0.88 to 0.97) for the risk of hypotension (area under curve (AUC): 0.95). For fluid responsiveness, the sensitivity and specificity of FTc were 0.79 (95% CI: 0.72 to 0.84) and 0.81 (95% CI: 0.75 to 0.86), respectively (AUC: 0.87). In contrast, the use of ΔVpeak to predict the risk of fluid responsiveness showed a pooled sensitivity of 0.76 (95% CI: 0.63 to 0.85) and specificity of 0.74 (95% CI: 0.66 to 0.8) (AUC: 0.79). The current meta-analysis provides robust evidence supporting the high diagnostic accuracy of FTc in predicting perioperative hypotension and fluid responsiveness, which requires further studies for verification.
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Affiliation(s)
- Kuo-Chuan Hung
- School of Medicine, College of Medicine, National Sun Yat-sen University, Kaohsiung City 80424, Taiwan
- Department of Anesthesiology, Chi Mei Medical Center, Tainan City 71004, Taiwan
| | - Yen-Ta Huang
- Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan City 70101, Taiwan
| | - Wen-Wen Tsai
- Department of Neurology, Chi Mei Medical Center, Tainan City 71004, Taiwan
| | - Ping-Heng Tan
- School of Medicine, College of Medicine, National Sun Yat-sen University, Kaohsiung City 80424, Taiwan
- Department of Anesthesiology, Chi Mei Medical Center, Tainan City 71004, Taiwan
| | - Jheng-Yan Wu
- Department of Nutrition, Chi Mei Medical Center, Tainan City 71004, Taiwan
| | - Po-Yu Huang
- Department of Internal Medicine, Chi Mei Medical Center, Tainan City 71004, Taiwan
| | - Ting-Hui Liu
- Department of General Internal Medicine, Chi Mei Medical Center, Tainan City 71004, Taiwan
| | - I-Wen Chen
- Department of Anesthesiology, Chi Mei Medical Center, Liouying, Tainan City 73657, Taiwan
| | - Cheuk-Kwan Sun
- Department of Emergency Medicine, E-Da Dachang Hospital, I-Shou University, Kaohsiung City 82445, Taiwan
- School of Medicine for International Students, College of Medicine, I-Shou University, Kaohsiung City 82445, Taiwan
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19
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Khorsand S, Chin J, Rice J, Bughrara N, Myatra SN, Karamchandani K. Role of Point-of-Care Ultrasound in Emergency Airway Management Outside the Operating Room. Anesth Analg 2023; 137:124-136. [PMID: 36693019 DOI: 10.1213/ane.0000000000006371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Tracheal intubation is one of the most frequently performed procedures in critically ill patients, and is associated with significant morbidity and mortality. Hemodynamic instability and cardiovascular collapse are common complications associated with the procedure, and are likely in patients with a physiologically difficult airway. Bedside point-of-care ultrasound (POCUS) can help identify patients with high risk of cardiovascular collapse, provide opportunity for hemodynamic and respiratory optimization, and help tailor airway management plans to meet individual patient needs. This review discusses the role of POCUS in emergency airway management, provides an algorithm to facilitate its incorporation into existing practice, and provides a framework for future studies.
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Affiliation(s)
- Sarah Khorsand
- From the Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Jeanette Chin
- From the Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Jake Rice
- From the Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Nibras Bughrara
- Department of Anesthesiology and Critical Care Medicine, Albany Medical College, Albany, New York
| | - Sheila N Myatra
- Department of Anesthesiology, Critical Care and Pain, Tata Memorial Hospital, Homi-Bhabha National Institute, Mumbai, India
| | - Kunal Karamchandani
- From the Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center, Dallas, Texas
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20
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Janssens U. Central venous pressure not appropriate to guide volume administration in patients with high-risk pulmonary embolism. Intensive Care Med 2023; 49:894-895. [PMID: 37221324 DOI: 10.1007/s00134-023-07094-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/05/2023] [Indexed: 05/25/2023]
Affiliation(s)
- Uwe Janssens
- Clinic Internal Medicine and Medical Intensive Care, St.-Antonius-Hospital, Dechant-Deckers-Str. 8, 52249, Eschweiler, Germany.
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21
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Ma Q, Ding C, Jiang F, Hu G, Wu J, Zhang X. RESPIRATORY VARIABILITY OF VALVULAR PEAK SYSTOLIC VELOCITY AS A NEW INDICATOR OF FLUID RESPONSIVENESS IN PATIENTS WITH SEPTIC SHOCK. Shock 2023; 60:11-17. [PMID: 37179247 PMCID: PMC10417229 DOI: 10.1097/shk.0000000000002142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 04/28/2023] [Indexed: 05/15/2023]
Abstract
ABSTRACT Objective: The aim of this study was to evaluate the reliability and feasibility of pulse Doppler measurements of peak velocity respiratory variability of mitral and tricuspid valve rings during systole as new dynamic indicators of fluid responsiveness in patients with septic shock. Methods: Transthoracic echocardiography (TTE) was performed to measure the respiratory variability of aortic velocity-time integral (∆VTI), respiratory variability of tricuspid annulus systolic peak velocity (∆RVS), respiratory variability of mitral annulus systolic peak velocity (∆LVS), and other related indicators. Fluid responsiveness was defined as a 10% increase in cardiac output after fluid expansion, assessed by TTE. Results: A total of 33 patients with septic shock were enrolled in this study. First, there was no significant difference in the population characteristics between the fluid responsiveness positive group (n = 17) and the fluid responsiveness negative group (n = 16) ( P > 0.05). Second, Pearson correlation test showed that ∆RVS, ∆LVS, and TAPSE with the relative increase in cardiac output after fluid expansion ( R = 0.55, P = 0.001; R = 0.40, P = 0.02; R = 0.36, P = 0.041). Third, multiple logistic regression analysis demonstrated that ∆RVS, ∆LVS, and TAPSE were significantly correlated with fluid responsiveness in patients with septic shock. Fourth, receiver operating characteristic (ROC) curve analysis revealed that ∆VTI, ∆LVS, ∆RVS, and TAPSE had good predictive ability for fluid responsiveness in patients with septic shock. The area under the curve (AUC) of ∆VTI, ∆LVS, ∆RVS, and TAPSE for predicting fluid responsiveness was 0.952, 0.802, 0.822, and 0.713, respectively. The sensitivity (Se) values were 1.00, 0.73, 0.81, and 0.83, whereas the specificity (Sp) values were 0.84, 0.91, 0.76, and 0.67, respectively. The optimal thresholds were 0.128, 0.129, 0.130, and 13.9 mm, respectively. Conclusion: Tissue Doppler ultrasound evaluation of respiratory variability of mitral and tricuspid annular peak systolic velocity could be a feasible and reliable method for the simple assessment of fluid responsiveness in patients with septic shock.
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Affiliation(s)
- Qiang Ma
- Department of Ultrasound, The First Affiliated Hospital of Wannan Medical College, Wuhu, Anhui, China
| | - Caiyun Ding
- Department of Physiology, Wannan Medical College, Wuhu, Anhui, China
| | - Feng Jiang
- Department of Ultrasound, The First Affiliated Hospital of Wannan Medical College, Wuhu, Anhui, China
| | - Guobin Hu
- Department of Ultrasound, The First Affiliated Hospital of Wannan Medical College, Wuhu, Anhui, China
| | - Jingyi Wu
- Department of Emergency Internal Medicine, The First Affiliated Hospital of Wannan Medical College, Wuhu, Anhui, China
| | - Xia Zhang
- Department of Ultrasound, The First Affiliated Hospital of Wannan Medical College, Wuhu, Anhui, China
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22
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Innocenti F, Savinelli C, Coppa A, Tassinari I, Pini R. Integrated ultrasonographic approach to evaluate fluid responsiveness in critically ill patients. Sci Rep 2023; 13:9159. [PMID: 37280235 DOI: 10.1038/s41598-023-36077-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 05/29/2023] [Indexed: 06/08/2023] Open
Abstract
In patients with acute circulatory failure, we tested the feasibility of the evaluation of the fluid-responsiveness (FR) by a combined approach with echocardiography and lung ultrasound. We enrolled 113 consecutive patients admitted to the Emergency Department High-Dependency Unit of Careggi University-Hospital from January 2015 to June 2020. We assessed: (1) inferior vena cava collapsibility index (IVCCI); (2) the variation of aortic flow (VTIAo) during the passive leg raising test (PLR); (3) the presence of interstitial syndrome by lung ultrasound. FR was defined as an increase in the VTIAo > 10% during PLR or IVCCI ≥ 40%. FR patients were treated with fluid and those non-FR with diuretics or vasopressors. The therapeutic strategy was reassessed after 12 h. The goal was to maintain the initial strategy. Among 56 FR patients, at lung ultrasound, 15 patients showed basal interstitial syndrome and 4 all-lung involvement. One fluid bolus was given to 51 patients. Among 57 non-FR patients, 26 patients showed interstitial syndrome at lung ultrasound (basal fields in 14, all lungs in 12). We administered diuretics to 21 patients and vasopressors to 4 subjects. We had to change the initial treatment plan in 9% non-FR patients and in 12% FR patients (p = NS). In the first 12 h after the evaluation, non-FR patients received significantly less fluids compared to those FR (1119 ± 410 vs 2010 ± 1254 ml, p < 0.001). The evaluation of the FR based on echocardiography and lung ultrasound was associated with the reduction in fluid administration for non-FR patients compared with those FR.
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Affiliation(s)
- Francesca Innocenti
- High-Dependency Unit, Department of Clinical and Experimental Medicine, Azienda Ospedaliero-Universitaria Careggi, Lg. Brambilla 3, 50134, Florence, Italy.
| | - Caterina Savinelli
- High-Dependency Unit, Department of Clinical and Experimental Medicine, Azienda Ospedaliero-Universitaria Careggi, Lg. Brambilla 3, 50134, Florence, Italy
| | - Alessandro Coppa
- High-Dependency Unit, Department of Clinical and Experimental Medicine, Azienda Ospedaliero-Universitaria Careggi, Lg. Brambilla 3, 50134, Florence, Italy
| | - Irene Tassinari
- High-Dependency Unit, Department of Clinical and Experimental Medicine, Azienda Ospedaliero-Universitaria Careggi, Lg. Brambilla 3, 50134, Florence, Italy
| | - Riccardo Pini
- High-Dependency Unit, Department of Clinical and Experimental Medicine, Azienda Ospedaliero-Universitaria Careggi, Lg. Brambilla 3, 50134, Florence, Italy
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23
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Lal J, Jain M, Rahul, Singh AK, Bansal T, Vashisth S. Efficacy of inferior vena cava collapsibility index and caval aorta index in predicting the incidence of hypotension after spinal anaesthesia- A prospective, blinded, observational study. Indian J Anaesth 2023; 67:523-529. [PMID: 37476444 PMCID: PMC10355364 DOI: 10.4103/ija.ija_890_22] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 05/05/2023] [Accepted: 05/08/2023] [Indexed: 07/22/2023] Open
Abstract
Background and Aim Spinal anaesthesia-induced hypotension (SAIH) is a frequent side effect of spinal anaesthesia. SAIH is usually observed in patients with hypovolemia. Ultrasonography has evolved as a non-invasive tool for volume status assessment. Methods This prospective, blinded, observational study was conducted on 75 adult patients who required spinal anaesthesia after receiving ethical approval and registering the study. Ultrasonographic evaluation of the aorta and the inferior vena cava (IVC) was done preoperatively, and the IVC collapsibility index (IVCCI) and caval aorta index were calculated. The incidence of SAIH was recorded. The strength of the association between different parameters and SAIH was calculated. To find out the value of the optimal cut-off for the prediction of SAIH, receiver operating characteristic (ROC) analysis for various ultrasound parameters was done. The bidirectional stepwise selection was utilised for multivariate analysis to choose the single best predictor. Results SAIH was observed in 36 patients. Among demographic parameters, age, female gender, and height showed a medium correlation. Among ultrasonographic measurements, minimum IVC internal diameter (IVCmin) and IVCCI showed a strong association with SAIH. The best parameter regarding area under the ROC curve (AUC) and diagnostic accuracy was IVCCI (0.828 and 85%, respectively). On multivariate analysis, age (95% CI [1.01, 1.12], P = 0.024) and IVCCI (95% CI [1.05, 1.18], P < 0.001) were significant independent predictors. At a cut-off point of ≥43.5%, IVCCI accurately predicted SAIH (sensitivity 81% and specificity 90%). Conclusion Preoperative ultrasonographic assessment of IVC to evaluate its collapsibility index is a convenient, cost-effective, and reproducible tool for predicting SAIH.
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Affiliation(s)
- Jatin Lal
- Department of Anaesthesiology, PGIMS, Rohtak, Haryana, India
| | - Mamta Jain
- Department of Anaesthesiology, PGIMS, Rohtak, Haryana, India
| | - Rahul
- Department of Critical Care Medicine, Max Superspeciality Hospital Saket, Delhi, India
| | | | - Teena Bansal
- Department of Anaesthesiology, PGIMS, Rohtak, Haryana, India
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Coraline E, Kim W, Paul V, Laurent S, Francesco D, Pierre B, Silke G. Post-mortem changes of the vascular system-a thanatological study using multidetector computed tomography. Int J Legal Med 2023:10.1007/s00414-023-02999-y. [PMID: 37099083 PMCID: PMC10247833 DOI: 10.1007/s00414-023-02999-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 04/06/2023] [Indexed: 04/27/2023]
Abstract
Forensic pathologists have to deal with post-mortem changes of the human body. Those post-mortem phenomena are familiar and largely described in thanatology. However, knowledge about the influence of post-mortem phenomena on the vascular system is more limited, except for the apparition and development of cadaveric lividity. The introduction of multidetector computed tomography (MDCT) and magnetic resonance imaging (MRI) in the forensic field and the expansion of their usage in medico-legal routine, allow for exploring the inside of corpses differently and may play a part in the understanding of thanatological processes. This study aimed to describe post-mortem changes in the vascular system by investigating the presence of gas and collapsed vessels.We investigated post-mortem MDCT data of 118 human bodies. Cases with internal/external bleeding or corporal lesion allowing contamination with external air were excluded. Major vessels and heart cavities were systematically explored and a trained radiologist semi-quantitatively assessed the presence of gas.Collapsed veins were observed in 61.9% of cases (CI95% 52.5 to 70.6) and arteries in 33.1% (CI95% 24.7 to 42.3). Vessels most often affected were for arteries: common iliac (16.1%), abdominal aorta (15.3%), external iliac (13.6%), and for veins: infra-renal vena cava (45.8%), common iliac (22.0%), renal (16.9%), external iliac (16.1%), and supra-renal vena cava (13.6%). Cerebral arteries and veins, coronary arteries, and subclavian vein were unaffected. The presence of collapsed vessels was associated with a minor degree of cadaveric alteration. We observed that arteries and veins follow the same pattern of gas apparition for both the quantity and the location.In post-mortem radiology, collapsed vessels and intravascular gas are frequently visualized and as a result of all post-mortem changes, the assessment of the distribution of blood can be confusing. Therefore, knowledge of thanatological phenomena is crucial to prevent post-mortem radiological misapprehensions and possible false diagnoses.
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Affiliation(s)
- Egger Coraline
- University Center of Legal Medicine Lausanne-Geneva, Rue Michel-Servet 1, 1211, Geneva, Switzerland.
- Geneva University Hospital and University of Geneva, Geneva, Switzerland.
| | - Wiskott Kim
- University Center of Legal Medicine Lausanne-Geneva, Rue Michel-Servet 1, 1211, Geneva, Switzerland
- Geneva University Hospital and University of Geneva, Geneva, Switzerland
| | - Vaucher Paul
- University Center of Legal Medicine Lausanne-Geneva, Chemin de la Vulliette 4, 1000, Lausanne, Switzerland
- University of Applied Sciences and Arts Western Switzerland (HES-SO), School of Health Sciences, Boulevard de Pérolles 80, 1700, Fribourg, Switzerland
| | - Suppan Laurent
- Geneva University Hospital and University of Geneva, Geneva, Switzerland
- Division of Emergency Medicine, Department of Anaesthesiology, Clinical Pharmacology, Intensive Care and Emergency Medicine, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, 1205, Genève, Switzerland
| | - Doenz Francesco
- Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
- Department of Radiology and Interventional Radiology, Centre Hospitalier Universitaire Vaudois (CHUV), Rue du Bugnon 46, 1011, Lausanne, Switzerland
| | - Bize Pierre
- Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
- Department of Radiology and Interventional Radiology, Centre Hospitalier Universitaire Vaudois (CHUV), Rue du Bugnon 46, 1011, Lausanne, Switzerland
| | - Grabherr Silke
- University Center of Legal Medicine Lausanne-Geneva, Rue Michel-Servet 1, 1211, Geneva, Switzerland
- Geneva University Hospital and University of Geneva, Geneva, Switzerland
- University Center of Legal Medicine Lausanne-Geneva, Chemin de la Vulliette 4, 1000, Lausanne, Switzerland
- Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
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Chong Y, Yu Y, Zhao Y, Zhang Y. Value of inferior vena cava diameter and inferior vena cava collapse index in the evaluation of peripartum volume: A prospective cohort study. Eur J Obstet Gynecol Reprod Biol 2023; 285:69-73. [PMID: 37062116 DOI: 10.1016/j.ejogrb.2023.03.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 01/31/2023] [Accepted: 03/31/2023] [Indexed: 04/18/2023]
Abstract
OBJECTIVE The maternal intravascular volume status assessed during and after gestation is valuable but challenging due to the influence of the substantial adaptive cardiovascular changes during pregnancy. The present study aimed to investigate the changes in the size of inferior vena cava (IVC) diameter and collapse index (IVC-CI) during perinatal delivery and whether it is affected by the change in intravascular volume during delivery. STUDY DESIGN A total of 31 full-term, singleton, and cephalic delivery women delivered by vagina with an estimated blood loss of >500 mL measured longitudinally between September 2019 and September 2020 in the Department of Obstetrics and Gynecology of The Third Hospital in China. The end-expiratory (IVCe) and end-inspiratory (IVCi) diameters of the inferior vena cava were measured at the first, second, and third stages of labor (T1, T2, and T3, respectively) and postpartum haemorrhage ≥500 mL (T4 and after rapid rehydration 500 mL (T5). The collapse index of IVC was calculated, and blood pressure and heart rate were measured. RESULTS IVCe and IVC-CI changed significantly in a volume-dependent manner during the perinatal period (T1-T5; P < 0.05). IVCe narrowed significantly with volume reduction (after postpartum hemorrhage) and widened significantly with volume increase (after volume resuscitation). IVC-CI increases significantly with decreased capacity and decreases significantly with increased capacity. CONCLUSION The width and collapse index of IVC reflect the circulatory volume changes during the parturient's perinatal period with postpartum hemorrhage.
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Affiliation(s)
- Yiwen Chong
- Peking University Third Hospital, Beijing, China
| | - Yang Yu
- Peking University Third Hospital, Beijing, China
| | - Yangyu Zhao
- Peking University Third Hospital, Beijing, China
| | - Yan Zhang
- Peking University Third Hospital, Beijing, China.
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Weber MD, Lim JKB, Ginsburg S, Conlon T, Nishisaki A. Translating Guidelines into Practical Practice: Point-of-Care Ultrasound for Pediatric Critical Care Clinicians. Crit Care Clin 2023; 39:385-406. [PMID: 36898781 DOI: 10.1016/j.ccc.2022.09.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Point-of-care ultrasound (POCUS) is now transitioning from an emerging technology to a standard of care for critically ill children. POCUS can provide immediate answers to clinical questions impacting management and outcomes within this fragile population. Recently published international guidelines specific to POCUS use in neonatal and pediatric critical care populations now complement previous Society of Critical Care Medicine guidelines. The authors review consensus statements within guidelines, identify important limitations to statements, and provide considerations for the successful implementation of POCUS in the pediatric critical care setting.
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Affiliation(s)
- Mark D Weber
- Division of Critical Care Medicine, Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA 19104, USA.
| | - Joel K B Lim
- Children's Intensive Care Unit, Department of Pediatric Subspecialties, KK Women's and Children's Hospital, Singapore
| | - Sarah Ginsburg
- Division of Critical Care Medicine, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Thomas Conlon
- Division of Critical Care Medicine, Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Akira Nishisaki
- Division of Critical Care Medicine, Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA 19104, USA
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Inferior Vena Cava Ultrasonography for Volume Status Evaluation: An Intriguing Promise Never Fulfilled. J Clin Med 2023; 12:jcm12062217. [PMID: 36983218 PMCID: PMC10053997 DOI: 10.3390/jcm12062217] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 03/02/2023] [Accepted: 03/07/2023] [Indexed: 03/14/2023] Open
Abstract
The correct determination of volume status is a fundamental component of clinical evaluation as both hypovolaemia (with hypoperfusion) and hypervolaemia (with fluid overload) increase morbidity and mortality in critically ill patients. As inferior vena cava (IVC) accounts for two-thirds of systemic venous return, it has been proposed as a marker of volaemic status by indirect assessment of central venous pressure or fluid responsiveness. Although ultrasonographic evaluation of IVC is relatively easy to perform, correct interpretation of the results may not be that simple and multiple pitfalls hamper its wider application in the clinical setting. In the present review, the basic elements of the pathophysiology of IVC behaviour, potential applications and limitations of its evaluation are discussed.
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Elia J, Diwan M, Deshpande R, Brainard JC, Karamchandani K. Perioperative Fluid Management and Volume Assessment. Anesthesiol Clin 2023; 41:191-209. [PMID: 36871999 DOI: 10.1016/j.anclin.2022.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2023]
Abstract
Fluid therapy is an integral component of perioperative care and helps maintain or restore effective circulating blood volume. The principal goal of fluid management is to optimize cardiac preload, maximize stroke volume, and maintain adequate organ perfusion. Accurate assessment of volume status and volume responsiveness is necessary for appropriate and judicious utilization of fluid therapy. To accomplish this, static and dynamic indicators of fluid responsiveness have been widely studied. This review discusses the overarching goals of perioperative fluid management, reviews the physiology and parameters used to assess fluid responsiveness, and provides evidence-based recommendations on intraoperative fluid management.
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Affiliation(s)
- Jennifer Elia
- Department of Anesthesiology, University of California, Irvine School of Medicine, 101 The City Drive South, Building 53-225, Orange, CA 92868, USA.
| | - Murtaza Diwan
- Department of Anesthesiology, University of Michigan, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA
| | - Ranjit Deshpande
- Department of Anesthesiology, Yale School of Medicine, 333Cedars Street, TMP 3, New Haven, CT 06510, USA
| | - Jason C Brainard
- Department of Anesthesiology, University of Colorado, University of Colorado Hospital, 12401 East 17th Avenue, Mail Stop B113, Aurora, CO 80045, USA
| | - Kunal Karamchandani
- Department of Anesthesiology and Pain Management, University of Texas, Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390, USA
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Campos NB, de Lima LB, Ferraz IDS, Nogueira RJN, Brandão MB, de Souza TH. Accuracy of Respiratory Variation in Inferior Vena Cava Diameter to Predict Fluid Responsiveness in Children Under Mechanical Ventilation. Pediatr Cardiol 2023:10.1007/s00246-023-03115-y. [PMID: 36759350 DOI: 10.1007/s00246-023-03115-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 01/27/2023] [Indexed: 02/11/2023]
Abstract
Proper assessment of fluid responsiveness using accurate predictors is crucial to guide fluid therapy and avoid the serious adverse effects of fluid overload. The main objective of this study was to investigate the accuracy of respiratory variations in inferior vena cava diameter (∆IVC) to predict fluid responsiveness in mechanically ventilated children. This prospective single-center study included 32 children (median age and weight of 17 months and 10 kg, respectively) who received a fluid infusion of 10 ml kg-1 of crystalloid solutions over 10 min. ∆IVC and respiratory variation in aortic blood flow peak velocity (∆Vpeak) were determined over one controlled respiratory cycle before and after fluid loading. Thirteen (41%) participants were fluid-responders. ∆IVC, ∆Vpeak, stroke volume index, and cardiac index were found to be predictors of fluid responsiveness. However, the area under the ROC curve of ∆IVC was smaller when compared to ∆Vpeak (0.709 vs. 0.935, p < 0.012). The best cut-off values were 7.7% for ∆IVC (sensitivity, 69.2%; specificity 78.9%, positive predictive value, 69.2%; and negative predictive value, 78.9%) and 18.2% for ∆Vpeak (sensitivity, 84.6%; specificity, 89.5%; positive predictive value, 84.6%; negative predictive value, 89.5%). Changes in stroke volume were positively correlated with ∆IVC (ρ = 0.566, p < 0.001) and ∆Vpeak (ρ = 0.603, p < 0.001). A significant correlation was also found between changes in MAP and ∆Vpeak (ρ = 0.382; p = 0.031), but the same was not observed with ∆IVC (ρ = 0.011; p = 0.951). In conclusion, ∆IVC was found to have a moderate accuracy in predicting fluid responsiveness in mechanically ventilated children and is an inferior predictor when compared to ∆Vpeak.
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Affiliation(s)
- Nathalia Barros Campos
- Pediatric Intensive Care Unit, Department of Pediatrics, State University of Campinas (UNICAMP), 126, Tessália Vieira de Camargo Street, Campinas, SP, 13083-887, Brazil
| | - Lícia Bertanha de Lima
- Pediatric Intensive Care Unit, Department of Pediatrics, State University of Campinas (UNICAMP), 126, Tessália Vieira de Camargo Street, Campinas, SP, 13083-887, Brazil
| | - Isabel de Siqueira Ferraz
- Pediatric Intensive Care Unit, Department of Pediatrics, State University of Campinas (UNICAMP), 126, Tessália Vieira de Camargo Street, Campinas, SP, 13083-887, Brazil
| | - Roberto J N Nogueira
- Pediatric Intensive Care Unit, Department of Pediatrics, State University of Campinas (UNICAMP), 126, Tessália Vieira de Camargo Street, Campinas, SP, 13083-887, Brazil
- Department of Pediatrics, School of Medicine, São Leopoldo Mandic, Campinas, SP, Brazil
| | - Marcelo B Brandão
- Pediatric Intensive Care Unit, Department of Pediatrics, State University of Campinas (UNICAMP), 126, Tessália Vieira de Camargo Street, Campinas, SP, 13083-887, Brazil
| | - Tiago H de Souza
- Pediatric Intensive Care Unit, Department of Pediatrics, State University of Campinas (UNICAMP), 126, Tessália Vieira de Camargo Street, Campinas, SP, 13083-887, Brazil.
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Córdova-Sánchez BM, Ñamendys-Silva SA, Pacheco-Bravo I, García-Guillén FJ, Mejía-Vilet JM, Cruz C, Barraza-Aguirre G, Ramírez-Talavera WO, López-Zamora AR, Monera-Martínez F, Vidal-Arellano LJ, Morales-Buenrostro LE. Renal arterial resistive index, monocyte chemotactic protein 1 and neutrophil gelatinase-associated lipocalin, for predicting acute kidney injury in critically ill cancer patients. Int Urol Nephrol 2023:10.1007/s11255-023-03504-5. [PMID: 36753015 DOI: 10.1007/s11255-023-03504-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 01/30/2023] [Indexed: 02/09/2023]
Abstract
PURPOSE We evaluated the renal arterial resistive index (RRI), urine monocyte chemotactic protein 1 (uMCP-1), and urine neutrophil gelatinase-associated lipocalin (uNGAL) to predict acute kidney injury (AKI) in critically ill cancer patients. METHODS In this prospective study, we included patients without AKI. We compared the area under the curve (AUC) of RRI, uMCP-1, and uNGAL to predict any stage of AKI and stage-3 AKI with the DeLong method, and we established cutoff points with the Youden index. RESULTS We included 64 patients, and 43 (67.2%) developed AKI. The AUC to predict AKI were: 0.714 (95% CI 0.587-0.820) for the RRI, 0.656 (95% CI 0.526-0.770) for uMCP-1, and 0.677 (95% CI 0.549-0.789) for uNGAL. The AUC to predict stage-3 AKI were: 0.740 (95% CI 0.615-0.842) for the RRI, 0.757 (95% CI 0.633-0.855) for uMCP-1, and 0.817 (95% CI 0.701-0.903) for uNGAL, without statistical differences among them. For stage 3 AKI prediction, the sensitivity and specificity were: 56.3% and 87.5% for a RRI > 0.705; 70% and 79.2% for an uMCP-1 > 2169 ng/mL; and 87.5% and 70.8% for a uNGAL > 200 ng/mL. The RRI was significantly correlated to age (r = 0.280), estimated glomerular filtration rate (r = - 0.259), mean arterial pressure (r = - 0.357), and serum lactate (r = 0.276). CONCLUSION The RRI, uMCP-1, and uNGAL have a similar ability to predict AKI. The RRI is more specific, while urine biomarkers are more sensitive to predict stage 3 AKI. The RRI correlates with hemodynamic variables. The novel uMCP-1 could be a useful biomarker that needs to be extensively studied.
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Affiliation(s)
| | - Silvio A Ñamendys-Silva
- Instituto Nacional de Cancerología, Mexico City, Mexico
- Nephrology Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Vasco de Quiroga 15, Sección XVI, Tlalpan, C. P. 14080, Mexico City, Mexico
- Hospital Medica Sur, Mexico City, Mexico
| | | | | | - Juan Manuel Mejía-Vilet
- Nephrology Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Vasco de Quiroga 15, Sección XVI, Tlalpan, C. P. 14080, Mexico City, Mexico
| | - Cristino Cruz
- Nephrology Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Vasco de Quiroga 15, Sección XVI, Tlalpan, C. P. 14080, Mexico City, Mexico
| | | | | | | | | | | | - Luis Eduardo Morales-Buenrostro
- Nephrology Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Vasco de Quiroga 15, Sección XVI, Tlalpan, C. P. 14080, Mexico City, Mexico.
- Hospital Medica Sur, Mexico City, Mexico.
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Garg S, Kapoor PM. POCUS and Fluid Responsiveness on Venoarterial ECMO. JOURNAL OF CARDIAC CRITICAL CARE TSS 2023. [DOI: 10.25259/jccc_4_2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
VA ECMO allows organ perfusion and oxygenation while awaiting myocardial recovery, cardiac transplantation, or long-term mechanical circulatory support. Diagnosis of hospital-acquired pneumonia (HAP) is a daily challenge for the clinician managing patients on venoarterial ECMO. Lung ultrasound (US) can be a valuable tool as the initial imaging modality for the diagnosis of pneumonia. Point-of-care US (POCUS) is broadly used in patients with ARDS. POCUS is recommended to be performed regularly in COVID-19 patients for respiratory failure management. In this review, we summarized the US characteristics of COVID-19 patients, mainly focusing on lung US and echocardiography. Point-of-care lung US (LUS) was demonstrated to be an effective tool in case of acute respiratory failure for ICU patients, community-acquired pneumonia, and ventilator-associated pneumonia. This review describes the usefulness of LUS in the early detection of HAP in cardiac critically ill patients under VA ECMO as well as assess its sonographic features.
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Affiliation(s)
- Sanchita Garg
- Department of Anesthesiolgy and Critical Care, Fortis Hospital, Mohali, Punjab, India,
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Kowalczyk D, Piotrowski WJ, Rosiak O, Białas AJ. Concise, Practical Review on Transthoracic Lung Ultrasound in Prehospital Diagnosis of Dyspnea in Adults. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:medicina59020224. [PMID: 36837426 PMCID: PMC9959919 DOI: 10.3390/medicina59020224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 01/16/2023] [Accepted: 01/22/2023] [Indexed: 01/26/2023]
Abstract
Ultrasonography is a relatively young but widely recognized method of imaging parenchymal organs, including the lungs. Our concise, practical review on transthoracic lung ultrasound (LUS) in the prehospital diagnosis of dyspnea in adults attempts to summarize current knowledge in the field. Furthermore, we discussed POCUS protocols in the analyzed context, discussing their usefulness. We concluded that bedside ultrasonography, or point of care (POCUS), is developing rapidly; however, the knowledge about the use of LUS in a pre-hospital setting is scarce, highlighting the need for further research in this field. Additionally, despite the possibility of using various ultrasound protocols in diagnosing a patient with dyspnea, there is no comprehensive and, at the same time, highly sensitive and specific protocol covering a satisfactory saccade of differential diagnosis of this symptom. It seems reasonable to conduct further targeted research to create such a dedicated solution.
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Affiliation(s)
- Damian Kowalczyk
- Department of Pneumology, Medical University of Lodz, 90-419 Lodz, Poland
- Correspondence:
| | | | - Oskar Rosiak
- Department of Otolaryngology, Polish Mother’s Memorial Hospital Research Institute, 90-419 Lodz, Poland
| | - Adam J. Białas
- Department of Pneumology, Medical University of Lodz, 90-419 Lodz, Poland
- Department of Pulmonary Rehabilitation, Center for Lung Diseases and Rehabilitation, Blessed Rafal Chylinski Memorial Hospital for Lung Diseases, 90-419 Lodz, Poland
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Pannu A. Circulatory shock in adults in emergency department. Turk J Emerg Med 2023. [PMID: 37529784 PMCID: PMC10389095 DOI: 10.4103/2452-2473.367400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Circulatory shock is a common condition that carries high morbidity and mortality. This review aims to update the critical steps in managing common types of shock in adult patients admitted to medical emergency and intensive care units. A literature review was performed by searching PubMed, EMBASE Ovid, and Cochrane Library, using the following search items: ("shock" OR "circulatory shock" OR "septic shock" OR "cardiogenic shock") AND ("management" OR "treatment" OR "resuscitation"). The review emphasizes prompt shock identification with tissue hypoperfusion, knowledge of the underlying pathophysiological mechanism, initial fluid resuscitation with balanced crystalloids, norepinephrine as the preferred vasopressor in septic and profound cardiogenic shock, and tailored intervention addressing specific etiologies. Point-of-care ultrasound may help evaluate an undifferentiated shock and determine fluid responsiveness. The approach to septic shock is improving; however, confirmatory studies are required for many existing (e.g., amount of initial fluids and steroids) and emerging (e.g., angiotensin II) therapies. Knowledge gaps and wide variations persist in managing cardiogenic shock that needs urgent addressing to improve outcomes.
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Solis‐McCarthy J, Gelabert C, Michalek J, Sisson C. The effect of continuous positive airway pressure on inferior vena cava collapsibility as measured by bedside ultrasound. J Am Coll Emerg Physicians Open 2022; 3:e12856. [DOI: 10.1002/emp2.12856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 10/27/2022] [Accepted: 10/31/2022] [Indexed: 12/03/2022] Open
Affiliation(s)
- Jessica Solis‐McCarthy
- Division of Ultrasound Department of Emergency Medicine University of Texas Health San Antonio 7703 Floyd Curl Drive, MC 7736 San Antonio Texas USA
| | - Christopher Gelabert
- Division of Ultrasound Department of Emergency Medicine University of Texas Health San Antonio 7703 Floyd Curl Drive, MC 7736 San Antonio Texas USA
| | - Joel Michalek
- Department of Population Health SciencesUniversity of Texas Health San Antonio San AntonioTexasUSA
| | - Craig Sisson
- Division of Ultrasound Department of Emergency Medicine University of Texas Health San Antonio 7703 Floyd Curl Drive, MC 7736 San Antonio Texas USA
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The diagnostic capabilities of the combined cardiac and lung point of care ultrasound in shocked patients at the emergency department - Resourced limited country. Eur J Radiol Open 2022; 9:100446. [PMID: 36250194 PMCID: PMC9554831 DOI: 10.1016/j.ejro.2022.100446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Revised: 10/05/2022] [Accepted: 10/06/2022] [Indexed: 11/04/2022] Open
Abstract
Purpose Cardiac, lung, and inferior vena cava (IVC) ultrasound are commonly performed in the care of emergency patients especially patient presented with hypotension or shock. However, the literature indicated the limitation of IVC to assess shocked patients. This study aims to determine the efficacy of combined cardiac and lung ultrasound for evaluation the etiology of shock. Materials and Methods A cross-sectional study was conducted on patient with shock at emergency department, Srinagarind Hospital, Thailand, from January to December 2021. Adult shocked patients who met the criteria were included in this study. Ultrasound and emergency department medical records were documented and analyzed as sensitivity, specificity, predictive value, negative predictive value, diagnostic accuracy, and Cohen's kappa coefficient (κ). Results One hundred and two who met the criteria were enrolled. Combined cardiac and lung scans were found to be accurate 99.02% and 93.04% in obstructive and cardiogenic shock. In patients with obstructive shock was the almost perfect agreement, (κ) = 0.85. However, distributive, and hypovolemic shock had the low concordance with the final hospital diagnosis, (κ) = 0.37 and 0.43, respectively. Conclusions The integration of cardiac and lung ultrasound can be effectively used to narrow differential diagnosis of shock.
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Abstract
Point-of-care ultrasound (POCUS) has evolved in recent years in clinical practice, helping in early bedside diagnosis of important etiologies. Many medical schools and training programs are integrating POCUS into their curriculum. Especially with the technological advances of newer handheld ultrasound devices, POCUS has now become a component adjunct to clinical examination, in the clinic and bedside in critical care units. The diagnostic utility of POCUS lies both in early identification of critical kidney disease, and also extra-renal pathologies from a focused cardiac ultrasound, lung ultrasound, and integrated fluid assessment. There is a need to incorporate POCUS in training in pediatric nephrology and establish competency standard criteria. This review shall cover how POCUS helps in enhancing patient care in pediatric kidney disorders and critical children, and the recent advances.
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Beels M, Stevens S, Saldien V. Perioperative fluid management in children: an updated review. ACTA ANAESTHESIOLOGICA BELGICA 2022. [DOI: 10.56126/73.3.03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
Background: Perioperative fluid management in children has been a major topic for debate.
Objectives: Our aim is to review the current evidence on perioperative fluid management in children including: type of fluid, administration rates, preoperative fluid intake and monitoring techniques.
Design: Narrative review.
Method: Following the PRISMA-S guidelines we performed a search (2010-March 2022) in databases Medline (through PubMed) and Cochrane Library. 4297 citations were found and screened by two independent researchers. After screening, 64 articles were withheld for our review.
Results: The perioperative administration of isotonic fluids is safer than hypotonic solutions, concerning the development of hyponatremia. A balanced isotonic solution with 1-2,5% glucose should be used as perioperative maintenance IV fluid in children (1 month to 18 years). Colloids can be used in children when inadequate effect in volume correction is achieved with crystalloids. The preferred synthetic colloid for children is a third generation HES in a balanced solution. To date, most clinicians use the “4-2-1 rule” for calculating fluid rate. This may not be the optimal fluid rate, as little research has been done. Preoperative fasting for clear fluids should be limited to 1 hour, children should even be encouraged to drink up until 1 hour before induction. Respiratory variation of aortic blood flow peak velocity (ΔVpeak) with echocardiography is currently the most reliable technique for evaluating fluid responsiveness in children.
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Ermini L, Seddone S, Policastro P, Mesin L, Pasquero P, Roatta S. The Cardiac Caval Index: Improving Noninvasive Assessment of Cardiac Preload. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2022; 41:2247-2258. [PMID: 34877689 DOI: 10.1002/jum.15909] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Revised: 11/04/2021] [Accepted: 11/19/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVES Inferior vena cava (IVC) pulsatility quantified by the Caval Index (CI) is characterized by poor reliability, also due to the irregular magnitude of spontaneous respiratory activity generating the major pulsatile component. The aim of this study was to test whether the IVC cardiac oscillatory component could provide a more stable index (Cardiac CI-CCI) compared to CI or respiratory CI (RCI). METHODS Nine healthy volunteers underwent long-term monitoring in supine position of IVC, followed by 3 minutes passive leg raising (PLR). CI, RCI, and CCI were extracted from video recordings by automated edge-tracking and CCI was averaged over each respiratory cycle (aCCI). Cardiac output (CO), mean arterial pressure (MAP) and heart rate (HR) were also recorded during baseline (1 minutes prior to PLR) and PLR (first minute). RESULTS In response to PLR, all IVC indices decreased (P < .01), CO increased by 4 ± 4% (P = .055) while HR and MAP did not vary. The Coefficient of Variation (CoV) of aCCI (13 ± 5%) was lower than that of CI (17 ± 5%, P < .01), RCI (26 ± 7%, P < .001) and CCI (25 ± 7%, P < .001). The mutual correlations in time of the indices were 0.81 (CI-RCI), 0.49 (CI-aCCI) and 0.2 (RCI-aCCI). CONCLUSIONS Long-term IVC monitoring by automated edge-tracking allowed us to evidence that 1) respiratory and averaged cardiac pulsatility components are uncorrelated and thus carry different information and 2) the new index aCCI, exhibiting the lowest CoV while maintaining good sensitivity to blood volume changes, may overcome the poor reliability of CI and RCI.
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Affiliation(s)
- Leonardo Ermini
- Laboratory of Integrative Physiology, Department of Neuroscience, Università di Torino, Torino, Italy
| | - Stefano Seddone
- Laboratory of Integrative Physiology, Department of Neuroscience, Università di Torino, Torino, Italy
| | - Piero Policastro
- Mathematical Biology and Physiology, Department of Electronics and Telecommunications, Politecnico di Torino, Torino, Italy
| | - Luca Mesin
- Mathematical Biology and Physiology, Department of Electronics and Telecommunications, Politecnico di Torino, Torino, Italy
| | - Paolo Pasquero
- Department of Medical Sciences, Università di Torino, Torino, Italy
| | - Silvestro Roatta
- Laboratory of Integrative Physiology, Department of Neuroscience, Università di Torino, Torino, Italy
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Ismail MT, El-iraky AA, Ibrahim EEDA, El.Kammash TH, Abou-Zied AE. Comparison of inferior vena cava collapsibility and central venous pressure in assessing volume status in shocked patients. Afr J Emerg Med 2022; 12:165-171. [PMID: 35599841 PMCID: PMC9120061 DOI: 10.1016/j.afjem.2022.04.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 03/25/2022] [Accepted: 04/11/2022] [Indexed: 11/26/2022] Open
Abstract
An accurate diagnosis of shock state can be challenging, particularly in low-income countries, such as African countries, because physical signs of hypovolaemic, distributive, cardiogenic, and obstructive shock frequently overlap. Low-income countries therefore require easy and noninvasive methods, such as ultrasound devices. This study aims to provide an accurate estimation of intravascular volume status using bedside noninvasive methods as an essential part of the management of shocked patients. We discovered that the inferior vena cava collapsibility index (IVC-ci) could be a good tool with moderate reliability for detecting fluid responsiveness because it is a less invasive and fast method.
Introduction Determination of intravascular volume status in patients admitted to the emergency centre is critical. Physical signs of hypovolaemic, distributive, cardiogenic, and obstructive shock frequently overlap, making an accurate diagnosis of shock state difficult. This is problematic because fluid loading is considered the first step in haemodynamically unstable patients’ resuscitation. Yet, multiple studies have shown that only approximately 50% of haemodynamically unstable patients in the intensive care unit and operating theatre respond to a fluid challenge. This study aims to provide an accurate estimation of intravascular volume status using bedside noninvasive methods as an essential part of the assessment of volume status in shocked patients. Methodology This is a cross-sectional analytical study conducted on 102 shocked patients presented to the emergency centre. IV fluid boluses were standardized to be administered at 500 mL every 30 min over 120 min, as clinically indicated. Concurrent measurements of inferior vena cava collapsibility index (IVC-ci) were performed shortly before the initiation of IV bolus (i.e., time 0), and then at 30, 90, and 120 min, we measured both venous collapsibility index (CI) and central venous pressure (CVP). At each session, we recorded patient demographics, fluid responsiveness, and vital sign assessments. Results We discovered that IVC-ci at cut-off point 40 has a sensitivity of 93.3% and specificity of 70.7% with an AUC of 0.908 and a good 95% CI (0.84–0.975), implying that IVC-ci of 40% or higher can indicate fluid responsiveness in shocked patients. CVP, despite having a good sensitivity of 88.6%, high specificity of 100%, and a significant p-value, is not a reliable detector of fluid responsiveness due to its small AUC value and low 95% CI. Conclusion IVC-ci could be a good tool with moderate reliability for detecting fluid responsiveness because it is a less invasive and fast method.
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Wang MK, Piticaru J, Kappel C, Mikhaeil M, Mbuagbaw L, Rochwerg B. Internal jugular vein ultrasound for the diagnosis of hypovolemia and hypervolemia in acutely ill adults: a systematic review and meta-analysis. Intern Emerg Med 2022; 17:1521-1532. [PMID: 35718838 DOI: 10.1007/s11739-022-03003-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Accepted: 05/10/2022] [Indexed: 11/05/2022]
Abstract
Accurate volume status assessments allow physicians to rapidly implement therapeutic measures in acutely unwell patients. However, existing bedside diagnostic tools are often unreliable for assessing intravascular volume. We searched PUBMED, EMBASE, CENTRAL, and Web of Science for English language articles without date restrictions on January 20, 2022. Studies reporting the diagnostic accuracy of IJV-US for hypovolemia and/or hypervolemia in an acute care setting were screened for inclusion. We included studies using any method of IJV-US assessment as the index test, compared against any reference standard. We fitted hierarchical summary receiver operating characteristic (HSROC) models for meta-analysis of diagnostic test accuracy, separately for hypovolemia and hypervolemia. Two reviewers independently extracted data and assessed risk of bias using QUADAS-2. We assessed certainty of evidence using the GRADE approach. A total of 26 studies were included, of which 19 studies (956 patients) examined IJV-US for hypovolemia and 13 studies (672 patients) examined IJV-US for hypervolemia. For the diagnosis of hypovolemia, IJV-US had a pooled sensitivity of 0.82 (95% CI 0.76 to 0.87; moderate-certainty evidence) and specificity of 0.82 (95% CI 0.73 to 0.88; moderate-certainty evidence). Measurement of IJV collapsibility indices had higher diagnostic accuracy (sensitivity 0.85, 95% CI 0.80 to 0.89; specificity 0.78, 95% CI 0.64 to 0.88) than static IJV indices (sensitivity 0.73, 95% CI 0.60 to 0.82; specificity 0.70, 95% CI 0.48 to 0.86). For the diagnosis of hypervolemia, IJV-US had a pooled sensitivity of 0.84 (95% CI 0.70 to 0.92; moderate-certainty evidence) and specificity of 0.70 (95% CI 0.55 to 0.82; very low-certainty evidence). IJV-US has moderate sensitivity and specificity for the diagnosis of hypervolemia and hypovolemia. Randomized controlled trials are needed to determine the role of IJV-US for guiding therapeutic interventions aimed at optimizing volume status.
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Affiliation(s)
- Michael Ke Wang
- Department of Medicine, McMaster University, Hamilton, Canada.
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Canada.
- Population Health Research Institute, McMaster University, 237 Barton Street East, Hamilton, ON, Canada.
| | - Joshua Piticaru
- Department of Medicine, St. Joseph's Hospital, Syracuse, NY, USA
| | - Coralea Kappel
- Department of Medicine, McMaster University, Hamilton, Canada
| | | | - Lawrence Mbuagbaw
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Canada
- Department of Anesthesia, McMaster University, Hamilton, Canada
- Biostatistics Unit, Father Sean O'Sullivan Research Centre, St Joseph's Healthcare, Hamilton, Canada
- Centre for Development of Best Practices in Health (CDBPH), Yaoundé Central Hospital, Yaoundé, Cameroon
- Department of Global Health, Stellenbosch University, Cape Town, South Africa
| | - Bram Rochwerg
- Department of Medicine, McMaster University, Hamilton, Canada
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Canada
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Piccioni A, Franza L, Rosa F, Manca F, Pignataro G, Salvatore L, Simeoni B, Candelli M, Covino M, Franceschi F. Use of POCUS in Chest Pain and Dyspnea in Emergency Department: What Role Could It Have? Diagnostics (Basel) 2022; 12:diagnostics12071620. [PMID: 35885525 PMCID: PMC9325275 DOI: 10.3390/diagnostics12071620] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 06/30/2022] [Accepted: 07/01/2022] [Indexed: 11/16/2022] Open
Abstract
Chest pain and dyspnea are common symptoms in patients presenting to the emergency room (ER); oftentimes it is not possible to clearly identify the underlying cause, which may cause the patient to have to return to the ER. In other cases, while it is possible to identify the underlying cause, it is necessary to perform a large number of tests before being able to make a diagnosis. Over the last twenty years, emergency medicine physicians have had the possibility of using ultrasound to help them make and rule out diagnoses. Specific ultrasound tests have been designed to evaluate patients presenting with specific symptoms to ensure a fast, yet complete, evaluation. In this paper, we examine the role of ultrasound in helping physicians understand the etiology behind chest pain and dyspnea. We analyze the different diseases and disorders which may cause chest pain and dyspnea as symptoms and discuss the corresponding ultrasound findings.
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Affiliation(s)
- Andrea Piccioni
- Department of Emergency Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (G.P.); (L.S.); (B.S.); (M.C.); (M.C.); (F.F.)
- Correspondence:
| | - Laura Franza
- Facoltà di Medicina e Chirurgia, Scuola di Specializzazione in Medicina d’Emergenza-Urgenza, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (L.F.); (F.R.); (F.M.)
| | - Federico Rosa
- Facoltà di Medicina e Chirurgia, Scuola di Specializzazione in Medicina d’Emergenza-Urgenza, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (L.F.); (F.R.); (F.M.)
| | - Federica Manca
- Facoltà di Medicina e Chirurgia, Scuola di Specializzazione in Medicina d’Emergenza-Urgenza, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (L.F.); (F.R.); (F.M.)
| | - Giulia Pignataro
- Department of Emergency Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (G.P.); (L.S.); (B.S.); (M.C.); (M.C.); (F.F.)
| | - Lucia Salvatore
- Department of Emergency Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (G.P.); (L.S.); (B.S.); (M.C.); (M.C.); (F.F.)
| | - Benedetta Simeoni
- Department of Emergency Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (G.P.); (L.S.); (B.S.); (M.C.); (M.C.); (F.F.)
| | - Marcello Candelli
- Department of Emergency Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (G.P.); (L.S.); (B.S.); (M.C.); (M.C.); (F.F.)
| | - Marcello Covino
- Department of Emergency Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (G.P.); (L.S.); (B.S.); (M.C.); (M.C.); (F.F.)
- Facoltà di Medicina e Chirurgia, Scuola di Specializzazione in Medicina d’Emergenza-Urgenza, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (L.F.); (F.R.); (F.M.)
| | - Francesco Franceschi
- Department of Emergency Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (G.P.); (L.S.); (B.S.); (M.C.); (M.C.); (F.F.)
- Facoltà di Medicina e Chirurgia, Scuola di Specializzazione in Medicina d’Emergenza-Urgenza, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (L.F.); (F.R.); (F.M.)
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Baba M, Alsbrook D, Williamson S, Soman S, Ramadan AR. Approach to the Management of Sodium Disorders in the Neuro Critical Care Unit. Curr Treat Options Neurol 2022. [DOI: 10.1007/s11940-022-00723-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Ultrasonographical Assessment of Caudal Vena Cava Size through Different Views in Healthy Calves: A Pilot Study. Vet Sci 2022; 9:vetsci9070308. [PMID: 35878325 PMCID: PMC9322146 DOI: 10.3390/vetsci9070308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 06/08/2022] [Accepted: 06/20/2022] [Indexed: 11/16/2022] Open
Abstract
Ultrasonographic measurements of the caudal vena cava (CVC) and aorta (Ao) are known as reliable tools to assess intravascular volume status in humans. The aim of this study was to evaluate the feasibility of obtaining ultrasonographical measurements of CVC and Ao in two different views, assess intra- and interobserver variability, and study the effect of sex, age, body weight, and breed on measurements in healthy calves. The diameter and area of CVC and Ao were measured by a single investigator in two anatomic sites (subxiphoid and paralumbar window) in 48 calves aged less than 60 days and then repeated 2.5 months after the first assessment. For intra- and interobserver variability assessment, CVC and Ao measurements were repeated by three observers on five randomly selected calves. CVC and Ao measurements were easily obtained in PV and more difficult to obtain in SV. CVC and Ao area in PV showed high repeatability and reproducibility. A positive correlation was highlighted between age and CVC and Ao measurements in both sites. In conclusion, CVC size assessment by point of care ultrasound can be easily performed at a paralumbar site in calves under 4 months of age and could be used to assess intravascular volume status.
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Shi J, Huang C, Zheng J, Ai Y, Liu H, Pan Z, Chen J, Shang R, Zhang X, Dong S, Lin R, Huang S, Huang J, Zhang C. Case Report: Tachycardia, Hypoxemia and Shock in a Severely Burned Pediatric Patient. Front Cardiovasc Med 2022; 9:904400. [PMID: 35783831 PMCID: PMC9243508 DOI: 10.3389/fcvm.2022.904400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 05/19/2022] [Indexed: 11/13/2022] Open
Abstract
Background Severely burned children are at high risk of secondary intraabdominal hypertension and abdominal compartment syndrome (ACS). ACS is a life-threatening condition with high mortality and requires an effective, minimally invasive treatment to improve the prognosis when the condition is refractory to conventional therapy. Case presentation A 4.5-year-old girl was admitted to our hospital 30 h after a severe burn injury. Her symptoms of burn shock were relieved after fluid resuscitation. However, her bloating was aggravated, and ACS developed on Day 5, manifesting as tachycardia, hypoxemia, shock, and oliguria. Invasive mechanical ventilation, vasopressors, and percutaneous catheter drainage were applied in addition to medical treatments (such as gastrointestinal decompression, diuresis, sedation, and neuromuscular blockade). These treatments did not improve the patient's condition until she received continuous renal replacement therapy. Subsequently, her vital signs and laboratory data improved, which were accompanied by decreased intra-abdominal pressure, and she was discharged after nutrition support, antibiotic therapy, and skin grafting. Conclusion ACS can occur in severely burned children, leading to rapid deterioration of cardiopulmonary function. Patients who fail to respond to conventional medical management should be considered for continuous renal replacement therapy.
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Affiliation(s)
- Jianshe Shi
- Department of Surgical Intensive Care Unit, Huaqiao University Affiliated Strait Hospital, Quanzhou, China
| | - Chuheng Huang
- Department of Surgical Intensive Care Unit, Huaqiao University Affiliated Strait Hospital, Quanzhou, China
| | - Jialong Zheng
- Department of Surgical Intensive Care Unit, Huaqiao University Affiliated Strait Hospital, Quanzhou, China
| | - Yeqing Ai
- Department of Surgical Intensive Care Unit, Huaqiao University Affiliated Strait Hospital, Quanzhou, China
| | - Hiufang Liu
- Department of Surgical Intensive Care Unit, Huaqiao University Affiliated Strait Hospital, Quanzhou, China
| | - Zhiqiang Pan
- Department of Surgical Intensive Care Unit, Huaqiao University Affiliated Strait Hospital, Quanzhou, China
| | - Jiahai Chen
- Department of Surgical Intensive Care Unit, Huaqiao University Affiliated Strait Hospital, Quanzhou, China
| | - Runze Shang
- Department of General Surgery, Huaqiao University Affiliated Strait Hospital, Quanzhou, China
| | - Xinya Zhang
- School of Medicine, Huaqiao University, Quanzhou, China
| | | | - Rongkai Lin
- Department of General Surgery, Huaqiao University Affiliated Strait Hospital, Quanzhou, China
| | - Shurun Huang
- Department of Burn, Huaqiao University Affiliated Strait Hospital, Quanzhou, China
| | - Jianlong Huang
- Key Laboratory of Intelligent Computing and Information Processing, Quanzhou Normal University, Quanzhou, China
- *Correspondence: Jianlong Huang
| | - Chenghua Zhang
- Department of General Surgery, Huaqiao University Affiliated Strait Hospital, Quanzhou, China
- Chenghua Zhang
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Kalkman LC, Hänscheid T, Krishna S, Grobusch MP. Fluid therapy for severe malaria. THE LANCET. INFECTIOUS DISEASES 2022; 22:e160-e170. [PMID: 35051406 DOI: 10.1016/s1473-3099(21)00471-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 07/20/2021] [Accepted: 07/28/2021] [Indexed: 06/14/2023]
Abstract
Fluid therapy is an important supportive measure for patients with severe malaria. Patients with severe malaria usually have normal cardiac index, vascular resistance, and blood pressure and a small degree of hypovolaemia due to dehydration. Cell hypoxia, reduced kidney function, and acidosis result from microcirculatory compromise and malarial anaemia, which reduce tissue oxygenation, not hypovolaemia. Hence, aggressive fluid loading does not correct acid-base status, enhance kidney function, or improve patient outcomes, and it risks complications such as pulmonary oedema. Individualised conservative fluid management is recommended in patients with severe malaria. Physical examination and physiological indices have limited reliability in guiding fluid therapy. Invasive measures can be more accurate than physical examination and physiological indices but are often unavailable in endemic areas, and non-invasive measures, such as ultrasound, are mostly unexplored. Research into reliable methods applicable in low-resource settings to measure fluid status and response is a priority. In this Review, we outline the current knowledge on fluid management in severe malaria and highlight research needed to optimise fluid therapy and improve survival in severe malaria.
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Affiliation(s)
- Laura C Kalkman
- Centre of Tropical Medicine and Travel Medicine, Amsterdam University Medical Centre, Department of Infectious Diseases, University of Amsterdam, Amsterdam, Netherlands; Centre de Recherches Médicales en Lambaréné, Lambaréné, Gabon
| | - Thomas Hänscheid
- Instituto de Microbiologia, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Sanjeev Krishna
- Centre de Recherches Médicales en Lambaréné, Lambaréné, Gabon; Clinical Academic Group, Institute for Infection and Immunity, and St George's University Hospitals NHS Foundation Trust, St George's University of London, London, UK; Institut für Tropenmedizin, Universitätsklinikum Tübingen, Tübingen, Germany
| | - Martin P Grobusch
- Centre of Tropical Medicine and Travel Medicine, Amsterdam University Medical Centre, Department of Infectious Diseases, University of Amsterdam, Amsterdam, Netherlands; Centre de Recherches Médicales en Lambaréné, Lambaréné, Gabon; Institut für Tropenmedizin, Universitätsklinikum Tübingen, Tübingen, Germany; Masanga Medical Research Unit, Masanga, Sierra Leone; Institute of Infectious Diseases and Molecular Medicine, University of Cape Town, Cape Town, South Africa.
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Zhao S, Ling Q, Liang F, Lin Z, Deng Y, Huang S, Zhu Q. Different preoperative fluids do not affect the hemodynamic status but gastric volume: results of a randomized crossover pilot study. BMC Anesthesiol 2022; 22:158. [PMID: 35610575 PMCID: PMC9128243 DOI: 10.1186/s12871-022-01697-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 05/09/2022] [Indexed: 11/21/2022] Open
Abstract
Background and objective Inferior vena cava (IVC) examination has been reported as a noninvasive method for evaluating the hemodynamic state. We conducted this crossover pilot study to investigate the effects of the administration of water and high-carbohydrate-containing fluids on the hemodynamic status of volunteers through collapsibility index of IVC (IVCCI) measurement. Methods Twenty volunteers were randomly assigned to a water or high-carbohydrate group according to computer-generated random numbers in a 1:1 ratio. In the water group, volunteers received water (5 mL/kg), and in the high-carbohydrate group, patients received carbohydrate drinks (5 mL/kg). Respiratory variations in the IVC diameter, gastric volume, and blood pressure and heart rates in erect and supine positions were measured at admission (T1), 1 h (T2), 2 h (T3), 3 h (T4), and 4 h (T5). Results When considering participants with an IVCCI of more than 42%, there were no significant differences between the water and carbohydrate drink groups at each time point (all p > 0.05). At T2, more participants had an empty stomach in water group than in carbohydrate drink group (p < 0.001). At T3, 30% of the participants could not empty their stomachs in carbohydrate drink group. However, with regard to the number of volunteers with empty stomach at T3, there was no significant difference between water and carbohydrate drink group. Repeated measures data analysis demonstrated that IVCCI showed no significant differences over time (p = 0.063 for T1-T5). There were no differences between water and carbohydrate drinks (p = 0.867). Conclusion Our results suggested that neither water nor carbohydrate drinking affected the hemodynamic status through IVCCI measurement over time, up to 4 h after drinking. Furthermore, carbohydrate drinking might delay gastric emptying at 1 h, but not 2 h after drinking, in comparison with water. Supplementary Information The online version contains supplementary material available at 10.1186/s12871-022-01697-3.
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Affiliation(s)
- Shuhua Zhao
- Department of Anesthesiology, The Seventh Affiliated Hospital of Sun Yat-Sen University, Shenzhen City, Guangdong Province, 518107, People's Republic of China.,Guangzhou Medical University, No.1 Xinzao Road, Panyu District, Guangzhou City, 511436, People's Republic of China
| | - Qiong Ling
- Department of Anesthesiology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou City, People's Republic of China
| | - Fengping Liang
- Department of Medical Ultrasound, The Seventh Affiliated Hospital of Sun Yat-sen University, Shenzhen City, People's Republic of China
| | - Zhongmei Lin
- Department of Anesthesiology, The Seventh Affiliated Hospital of Sun Yat-Sen University, Shenzhen City, Guangdong Province, 518107, People's Republic of China
| | - Yingqing Deng
- Department of Anesthesiology, The Seventh Affiliated Hospital of Sun Yat-Sen University, Shenzhen City, Guangdong Province, 518107, People's Republic of China
| | - Shaonong Huang
- Guangzhou Medical University, No.1 Xinzao Road, Panyu District, Guangzhou City, 511436, People's Republic of China.
| | - Qianqian Zhu
- Department of Anesthesiology, The Seventh Affiliated Hospital of Sun Yat-Sen University, Shenzhen City, Guangdong Province, 518107, People's Republic of China.
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Ma Q, Ji J, Shi X, Lu Z, Xu L, Hao J, Zhu W, Li B. Comparison of superior and inferior vena cava diameter variation measured with transthoracic echocardiography to predict fluid responsiveness in mechanically ventilated patients after abdominal surgery. BMC Anesthesiol 2022; 22:150. [PMID: 35581547 PMCID: PMC9112503 DOI: 10.1186/s12871-022-01692-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 04/22/2022] [Indexed: 11/29/2022] Open
Abstract
Background The volume status of patients after major abdominal surgery constantly varies owing to postoperative diverse issues comprising fluid loss or capillary leakage secondary to systemic inflammatory reaction syndrome, et.al, the precise fluid responsiveness assessment is crucial for those patients. The purpose of this study is to validate the transthoracic ultrasonographic measurement of superior and inferior vena cava variation in predicting fluid responsiveness of mechanically ventilated patients after surgery. Methods A total of 70 patients undergoing the scheduled major abdominal surgeries in the anesthesia ICU ward were included. The superior vena cava (SVC) collapsibility index (SVCCI), the inferior vena cava distensibility index (dIVC), SVC variation over the cardiac cycle (SVCV), and cardiac output (CO) were measured by transthoracic ultrasonography were recorded before and after fluid challenge test of 5 ml/kg crystalloid within 15 min. The responders were defined as a 15% or more increment in CO. Results Thirty patients (42.9%) responded to fluid challenge, while the remnant forty patients (57.1%) did not. The areas under the ROC curve (AUC) of SVCCI, dIVC and SVCV were 0.885 (95% CI, 0.786–0.949; P < 0.0001) and 0.727 (95% CI, 0.608–0.827; P < 0.001) and 0.751 (95% CI, 0.633–0.847; P < 0.0001), respectively. AUCdIVC and AUCSVCV were significantly lower when compared with AUCSVCCI (P < 0.05). The optimal cutoff values were 19% for SVCCI, 14% for dIVC, and 15% for SVCV. The gray zone for SVCCI was 20%-25% and included 15.7% of patients, while 7%-27% for dIVC including 62.9% of patients and 9%-21% for SVCV including 50% of patients. Conclusion Superior vena cava-related parameters measured by transthoracic ultrasound are reliable indices to predict fluid responsiveness. The accuracy of SVCCI in mechanically ventilated patients after abdominal surgery is better than that of dIVC and SVCV. Trial registration ChiCTR-INR-17013093. The initial registration date was 24/10/2017.
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Affiliation(s)
- Qian Ma
- Department of Anesthesiology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, 321 Zhongshan Road, Nanjing, 210008, Jiangsu, China
| | - Jingjing Ji
- Department of Anesthesiology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, 321 Zhongshan Road, Nanjing, 210008, Jiangsu, China
| | - Xueduo Shi
- Department of Anesthesiology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, 321 Zhongshan Road, Nanjing, 210008, Jiangsu, China
| | - Ziyun Lu
- Department of Anesthesiology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, 321 Zhongshan Road, Nanjing, 210008, Jiangsu, China
| | - Lu Xu
- Department of Anesthesiology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, 321 Zhongshan Road, Nanjing, 210008, Jiangsu, China
| | - Jing Hao
- Department of Anesthesiology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, 321 Zhongshan Road, Nanjing, 210008, Jiangsu, China
| | - Wei Zhu
- Department of Anesthesiology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, 321 Zhongshan Road, Nanjing, 210008, Jiangsu, China
| | - Bingbing Li
- Department of Anesthesiology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, 321 Zhongshan Road, Nanjing, 210008, Jiangsu, China.
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Haldeman MS, Kunka E, Makasa M, Birkland B. Resident perception on the impact of point-of-care ultrasound in clinical care at a family medicine training program in Zambia. Ultrasound J 2022; 14:18. [PMID: 35569051 PMCID: PMC9107583 DOI: 10.1186/s13089-022-00273-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 05/02/2022] [Indexed: 11/14/2022] Open
Abstract
Background Patient access to necessary medical imaging in low- and middle-income countries (LMICs) remains a major obstacle, complicating clinician decision-making and compromising patient outcomes. Methods We implemented a longitudinal point-of-care ultrasound (POCUS) training program at a new Family Medicine residency in Zambia and subsequently evaluated residents’ perceptions on the impact of POCUS in patient care. Data were documented by the scanning resident via a post-scan survey, which assessed if/how the scan assisted in medical management, and if/how the scan changed that management. The primary endpoint was frequency of scans assisting and changing management. Data were summarized using descriptive statistics. Results Over the 1-year study period, 366 patient encounters occurred in which POCUS was utilized, resulting in a total of 542 unique POCUS scans. POCUS assisted in decision-making in 95.6% (350/366) of patient encounters, most commonly by helping to determine a diagnosis. POCUS changed management in 65.8% (235/357) of patient encounters, most commonly leading to a medication change. Conclusions Zambian resident physicians perceived POCUS to be very helpful in their clinical decision-making. These data support the need to advance POCUS education at the residency level throughout LMICs, which may be an ideal strategy to promote widespread utilization of POCUS in low-resource settings globally.
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Affiliation(s)
- Matthew S Haldeman
- Department of Community and Family Medicine, School of Public Health, University of Zambia, P.O. Box 50110, Lusaka, Zambia. .,Seed Global Health, 20 Ashburton Place, Boston, MA, 02108, USA.
| | - Evaristo Kunka
- Department of Community and Family Medicine, School of Public Health, University of Zambia, P.O. Box 50110, Lusaka, Zambia
| | - Mpundu Makasa
- Department of Community and Family Medicine, School of Public Health, University of Zambia, P.O. Box 50110, Lusaka, Zambia
| | - Bassim Birkland
- Department of Community and Family Medicine, School of Public Health, University of Zambia, P.O. Box 50110, Lusaka, Zambia.,Seed Global Health, 20 Ashburton Place, Boston, MA, 02108, USA
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Güllüpınar B, Sağlam C, Koran S, Turhan A, Ünlüer EE. The role of mitral annular plane systolic excursion in prediction of acute blood loss in healthy voluntary blood donors. J Ultrason 2022; 22:e33-e38. [PMID: 35449700 PMCID: PMC9009345 DOI: 10.15557/jou.2022.0006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Accepted: 01/13/2022] [Indexed: 11/22/2022] Open
Abstract
Aim The aim of this study is to compare the diameter of the inferior vena cava with mitral annular plane systolic excursion measurement in order to determine the volume loss before and after blood donation in healthy volunteers. Material and methods The study was a single-center, prospective, cross-sectional study which included 46 healthy blood donors donating in a tertiary care hospital's blood bank. The inclusion criteria for the study were: volunteers aged 18-65 years, over 50 kg in weight, who met blood donation criteria, with hemoglobin values of >13.5 g/dL for males and >12.5 g/dL for females. After obtaining written consent, the systolic, diastolic, and mean arterial blood pressure along with the pulse rate of the donors were measured in standing and lying positions by the attending physician. Next, inferior vena cava and mitral annular plane systolic excursion measurements were made both pre and post blood donation. Results The decrease in both inferior vena cava diameter and mitral annular plane systolic excursion values measured pre and post blood donation was found to be statistically significant (p <0.05). There was no difference between the other variables pre and post blood donation. Conclusions Our study revealed that decreased inferior vena cava and mitral annular plane systolic excursion values correlated in determining blood loss post blood donation. Mitral annular plane systolic excursion may be useful to predict blood loss in the early stages of hemorrhagic shock.
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Affiliation(s)
- Birdal Güllüpınar
- Department of Emergency Medicine, Izmir Bozyaka Training and Research Hospital, Turkey
| | - Caner Sağlam
- Department of Emergency Medicine, Izmir Bozyaka Training and Research Hospital, Turkey
| | - Serhat Koran
- Department of Family Medicine, Bagcılar Medipol University Hospital, Turkey
| | | | - Erden Erol Ünlüer
- Department of Emergency Medicine, Izmir Bozyaka Training and Research Hospital, Turkey
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Ma Q, Shi X, Ji J, Chen L, Tian Y, Hao J, Li B. The diagnostic accuracy of inferior vena cava respiratory variation in predicting volume responsiveness in patients under different breathing status following abdominal surgery. BMC Anesthesiol 2022; 22:63. [PMID: 35260075 PMCID: PMC8903007 DOI: 10.1186/s12871-022-01598-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 02/22/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The validation of inferior vena cava (IVC) respiratory variation for predicting volume responsiveness is still under debate, especially in spontaneously breathing patients. The present study aims to verify the effectiveness and accuracy of IVC variability for volume assessment in the patients after abdominal surgery under artificially or spontaneously breathing. METHODS A total of fifty-six patients after abdominal surgeries in the anesthesia intensive care unit ward were included. All patients received ultrasonographic examination before and after the fluid challenge of 5 ml/kg crystalloid within 15 min. The same measurements were performed when the patients were extubated. The IVC diameter, blood flow velocity-time integral of the left ventricular outflow tract, and cardiac output (CO) were recorded. Responders were defined as an increment in CO of 15% or more from baseline. RESULTS There were 33 (58.9%) mechanically ventilated patients and 22 (39.3%) spontaneously breathing patients responding to fluid resuscitation, respectively. The area under the curve was 0.80 (95% CI: 0.68-0.90) for the IVC dimeter variation (cIVC1) in mechanically ventilated patients, 0.87 (95% CI: 0.75-0.94) for the collapsibility of IVC (cIVC2), and 0.85 (95% CI: 0.73-0.93) for the minimum IVC diameter (IVCmin) in spontaneously breathing patients. The optimal cutoff value was 15.32% for cIVC1, 30.25% for cIVC2, and 1.14 cm for IVCmin. Furthermore, the gray zone for cIVC2 was 30.72 to 38.32% and included 23.2% of spontaneously breathing patients, while 17.01 to 25.93% for cIVC1 comprising 44.6% of mechanically ventilated patients. Multivariable logistic regression analysis indicated that cIVC was an independent predictor of volume assessment for patients after surgery irrespective of breathing modes. CONCLUSION IVC respiratory variation is validated in predicting patients' volume responsiveness after abdominal surgery irrespective of the respiratory modes. However, cIVC or IVCmin in spontaneously breathing patients was superior to cIVC in mechanically ventilated patients in terms of clinical utility, with few subjects in the gray zone for the volume responsiveness appraisal. TRIAL REGISTRATION ChiCTR-INR-17013093 . Initial registration date was 24/10/2017.
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Affiliation(s)
- Qian Ma
- Department of Anesthesiology, Nanjing Drum Tower Hospital, The Affiliated Hosptial of Nanjing University Medical School, 321 Zhongshan Road, 210008, Nanjing, China
| | - Xueduo Shi
- Department of Anesthesiology, Nanjing Drum Tower Hospital, The Affiliated Hosptial of Nanjing University Medical School, 321 Zhongshan Road, 210008, Nanjing, China
| | - Jingjing Ji
- Department of Anesthesiology, Nanjing Drum Tower Hospital, The Affiliated Hosptial of Nanjing University Medical School, 321 Zhongshan Road, 210008, Nanjing, China
| | - Luning Chen
- Department of Anesthesiology, Nanjing Drum Tower Hospital, The Affiliated Hosptial of Nanjing University Medical School, 321 Zhongshan Road, 210008, Nanjing, China
| | - Yali Tian
- Department of Anesthesiology, Nanjing Drum Tower Hospital, The Affiliated Hosptial of Nanjing University Medical School, 321 Zhongshan Road, 210008, Nanjing, China
| | - Jing Hao
- Department of Anesthesiology, Nanjing Drum Tower Hospital, The Affiliated Hosptial of Nanjing University Medical School, 321 Zhongshan Road, 210008, Nanjing, China
| | - Bingbing Li
- Department of Anesthesiology, Nanjing Drum Tower Hospital, The Affiliated Hosptial of Nanjing University Medical School, 321 Zhongshan Road, 210008, Nanjing, China.
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