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Guinot PG, Bahr PA, Andrei S, Popescu BA, Caruso V, Mertes PM, Berthoud V, Nguyen M, Bouhemad B. Doppler study of portal vein and renal venous velocity predict the appropriate fluid response to diuretic in ICU: a prospective observational echocardiographic evaluation. Crit Care 2022; 26:305. [PMID: 36199091 PMCID: PMC9535945 DOI: 10.1186/s13054-022-04180-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Accepted: 09/28/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Fluid overload and venous congestion are associated with morbi-mortality in the ICU (intensive care unit). Administration of diuretics to correct the fluid balance is common, although there is no strong relationship between the consequent fluid loss and clinical improvement. The aim of the study was to evaluate the ability of the portal pulsatility index, the renal venous impedance index, and the VEXUS score (venous ultrasound congestion score) to predict appropriate diuretic-induced fluid depletion. METHODS The study had a prospective, observational, single-center observational design and was conducted in a university-affiliated medico-surgical ICU. Adult patients for whom the clinician decided to introduce loop diuretic treatment were included. Hemodynamic and ultrasound measurements (including the portal pulsatility index, renal venous impedance index and VEXUS score) were performed at inclusion and 2 hours after the initiation of the diuretics. The patients' characteristics were noted at inclusion, 24 h later, and at ICU discharge. The appropriate diuretic-induced fluid depletion was defined by a congestive score lower than 3 after diuretic fluid depletion. The congestive score included clinical and biological parameters of congestion. RESULTS Eighty-one patients were included, and 43 (53%) patients presented with clinically significant congestion score at inclusion. Thirty-four patients (42%) had an appropriate response to diuretic-induced fluid depletion. None of the left- and right-sided echocardiographic parameters differed between the two groups. The baseline portal pulsatility index was the best predictor of appropriate response to diuretic-induced fluid depletion (AUC = 0.80, CI95%:0.70-0.92, p = 0.001), followed by the renal venous impedance index (AUC = 0.72, CI95% 0.61-0.84, p = 0.001). The baseline VEXUS score (AUC of 0.66 CI95% 0.53-0.79, p = 0.012) was poorly predictive of appropriate response to diuretic-induced fluid depletion. CONCLUSION The portal pulsatility index and the renal venous impedance index were predictive of the appropriate response to diuretic-induced fluid depletion in ICU patients. The portal pulsatility index should be evaluated in future randomized studies.
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Affiliation(s)
- Pierre-Grégoire Guinot
- grid.5613.10000 0001 2298 9313Department of Anaesthesiology and Critical Care Medicine, Dijon University Medical Centre, 21000 Dijon, France ,grid.5613.10000 0001 2298 9313University of Burgundy and Franche-Comté, LNC UMR1231, 21000 Dijon, France
| | - Pierre-Alain Bahr
- grid.5613.10000 0001 2298 9313Department of Anaesthesiology and Critical Care Medicine, Dijon University Medical Centre, 21000 Dijon, France ,grid.5613.10000 0001 2298 9313University of Burgundy and Franche-Comté, LNC UMR1231, 21000 Dijon, France
| | - Stefan Andrei
- grid.5613.10000 0001 2298 9313Department of Anaesthesiology and Critical Care Medicine, Dijon University Medical Centre, 21000 Dijon, France ,grid.8194.40000 0000 9828 7548Department of Anaesthesiology and Critical Care Medicine, University of Medicine and Pharmacy “Carol Davila”, Bucharest, Romania
| | - Bogdan A. Popescu
- Euroecolab, Emergency Institute for Cardiovascular Diseases “Prof Dr C C Iliescu”, Bucharest, Romania
| | - Vincenza Caruso
- grid.5613.10000 0001 2298 9313Department of Anaesthesiology and Critical Care Medicine, Dijon University Medical Centre, 21000 Dijon, France
| | - Paul-Michel Mertes
- grid.11843.3f0000 0001 2157 9291Department of Anaesthesiology and Critical Care Medicine, Strasbourg University Medical Centre, Strasbourg, France
| | - Vivien Berthoud
- grid.5613.10000 0001 2298 9313Department of Anaesthesiology and Critical Care Medicine, Dijon University Medical Centre, 21000 Dijon, France
| | - Maxime Nguyen
- grid.5613.10000 0001 2298 9313Department of Anaesthesiology and Critical Care Medicine, Dijon University Medical Centre, 21000 Dijon, France ,grid.5613.10000 0001 2298 9313University of Burgundy and Franche-Comté, LNC UMR1231, 21000 Dijon, France
| | - Belaid Bouhemad
- grid.5613.10000 0001 2298 9313Department of Anaesthesiology and Critical Care Medicine, Dijon University Medical Centre, 21000 Dijon, France ,grid.5613.10000 0001 2298 9313University of Burgundy and Franche-Comté, LNC UMR1231, 21000 Dijon, France
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Effect of sampling time on urinary electrolytes following oral furosemide administration in dogs with myxomatous mitral valve disease. J Vet Cardiol 2022; 41:57-69. [DOI: 10.1016/j.jvc.2022.01.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 01/26/2022] [Accepted: 01/27/2022] [Indexed: 11/23/2022]
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