COUNTERPOINT: Should Acute Fluid Resuscitation Be Guided Primarily by Inferior Vena Cava Ultrasound for Patients in Shock? No

Abstract

Dr. Kory received a stipend from Sonosite/Fuijifilm to provide a video based tutorial based on how to diagnose a deep vein thrombosis using ultrasound.

Caudal vena cava collapsibility index as a tool to predict fluid responsiveness in dogs

“…The haemodynamic response of septic patients to fluid challenges might differ from that observed in hypovolemic patients. 25 As previously observed in human medicine, 14 the basal VTI in nonresponder dogs was higher compared to responders. Unlike previous reports describing fluid responsiveness in dogs, 12,13,26 responders in this study had significantly higher heart rates than nonresponders.…”

“…Unlike the quoted study, 24 our study included a heterogeneous population with only few septic patients. The haemodynamic response of septic patients to fluid challenges might differ from that observed in hypovolemic patients 25 . The endothelial dysfunction might alter the rate of fluid shift out from the intravascular compartment and the duration of the response to the fluid challenge.…”

Does respiratory variation of inferior vena cava diameter predict fluid responsiveness in spontaneously ventilating children with sepsis

“…The majority of these studies enrolled mixed patient populations, including those with trauma, dehydration and postoperative surgical patients. The haemodynamic response to FBT in patients with systemic inflammation may differ from that observed in patients with fluid loss; endothelial dysfunction may significantly influence the rate of fluid shift out of the intravascular compartment and the duration of effect of FBT . In addition, the underlying haemodynamic abnormalities and response to treatment differ between septic children and adults, with a higher incidence of septic myocardial dysfunction and ‘cold shock’ in the former, and vaso/venoplegic ‘warm shock’ in the latter .…”

“…Respiratory variation in IVC diameter as a predictor of fluid responsiveness has generated considerable interest and controversy in the critical care literature . The argument against IVC collapsibility index as a predictor of fluid responsiveness is based on pooled central venous pressure (CVP) data, indicating that CVP and change in CVP with FBT are poor predictors of fluid responsiveness .…”

“…Respiratory variation in IVC diameter as a predictor of fluid responsiveness has generated considerable interest and controversy in the critical care literature. 26,27 The argument against IVC collapsibility index as a predictor of fluid responsiveness is based on pooled central venous pressure (CVP) data, indicating that CVP and change in CVP with FBT are poor predictors of fluid responsiveness. 28 Respiratory variation in IVC diameter occurs in part because of changes in CVP, as well as changes in several additional parameters, including the magnitude of intrathoracic pressure changes with respiration, venous compliance and intra-abdominal pressure.…”