Portal congestion and intestinal edema in hospitalized patients with heart failure

Ikeda, Yuki; Ishii, Shunsuke; Yazaki, Mayu; Fujita, Toshio; Iida, Yuichiro; Kaida, Toyoji; Nabeta, Takeru; Nakatani, Eiji; Maekawa, Emi; Yanagisawa, Tomoyoshi; Koitabashi, Toshimi; Inomata, Takayuki; Ako, Junya

doi:10.1007/s00380-018-1117-5

Cited by 40 publications

(29 citation statements)

References 41 publications

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“…In patients with congestive heart failure, pulsatile portal flow is the echographic parameter most predictive of an abnormal increase in serum bilirubin, 93 and the detection of portal congestion is associated with adverse outcomes. 94 In cardiac surgery, the detection of portal flow pulsatility was associated with a higher risk of AKI in a retrospective study. 95 This association was confirmed in a prospective study in 145 cardiac surgery patients in which the detection of pulsatile portal flow was associated with a higher Parasympathetic ✓ risk of AKI (HR: 2.09, CI: 1.11-3.94, p = 0.02) and severe AKI (HR: 5.12, CI: 1.47-17.9 p = 0.01).…”

Section: Complementing Hemodynamic Assessment With Pocusmentioning

confidence: 99%

The Role of Point-of-Care Ultrasound Monitoring in Cardiac Surgical Patients With Acute Kidney Injury

Beaubien‐Souligny

Denault

Robillard

et al. 2019

Journal of Cardiothoracic and Vascular Anesthesia

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The approach to the patient with acute kidney injury (AKI) after cardiac surgery involves multiple aspects. These include the rapid recognition of reversible causes, the accurate identification of patients who will progress to severe stages of AKI, and the subsequent management of complications resulting from severe renal dysfunction. Unfortunately, the inherent limitations of physical examination and laboratory parameter results are often responsible for suboptimal clinical management. In this review article, the authors explore how point-of-care ultrasound, including renal and extrarenal ultrasound, can be used to complement all aspects of the care of cardiac surgery patients with AKI, from the initial approach of early AKI to fluid balance management during renal replacement therapy. The current evidence is reviewed, including knowledge gaps and future areas of research.

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Section: Complementing Hemodynamic Assessment With Pocusmentioning

confidence: 99%

The Role of Point-of-Care Ultrasound Monitoring in Cardiac Surgical Patients With Acute Kidney Injury

Beaubien‐Souligny

Denault

Robillard

et al. 2019

Journal of Cardiothoracic and Vascular Anesthesia

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“…21 Abnormal or discontinuous portal flow was defined for values of PVPI >50%. 14,15,21,22 Intrarenal venous flow (IRVF) using renal Doppler ultrasonography at the level of renal parenchymal veins was used for profiling intrarenal hemodynamics as presented in Figure 1 and was obtained as previously published. 13,23 Abnormal or discontinuous IRVF patterns have been related to increased interstitial pressures within the kidney in the setting of increased venous congestion.…”

Section: Ultrasound Assessment Of Portal and Renal Doppler Flowmentioning

confidence: 99%

Impacts of right ventricular function and venous congestion on renal response during depletion in acute heart failure

et al. 2020

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Aims Venous congestion is a major determinant of worsening renal function (WRF) in acute decompensated heart failure (ADHF), particularly when associated with right ventricular (RV) dysfunction. Whether the individual impacts of hemodynamic variables on renal outcomes in ADHF is modified according to RV function remains unclear. We aimed to determine the association between hemodynamic parameters and early changes in renal function during depletive therapy and explore the association of these changes with clinical outcomes. Methods and results WRF was defined as any increase in creatinine after 24 h of depletive therapy and improvement in renal function (IRF) as any decrease. Assessments were prospectively obtained on admission, 24 h later and at discharge. Out of the 105 patients enrolled, 45% had IRF, and 41% had poor RV. At baseline, patients evolving towards IRF had a lower mean arterial pressure (84.7 ± 13.9 vs. 90.9 ± 15.2 mmHg), a lower renal perfusion pressure (69.4 ± 16.2 vs. 75.4 ± 15.1 mmHg), and a poorer RV function (tricuspid annular plan systolic excursion 16.5 ± 6.0 vs. 18.8 ± 5.6 mm) in comparison with those with WRF (all P < 0.05). In a multivariate linear regression model, tricuspid annular plane systolic excursion was the dominant parameter correlated with early changes in creatinine when RV was poor (β = 0.337), whereas mean arterial pressure (β = À0.334) and cardiac output (β = À0.298) were the only parameters correlated with renal function in patients with preserved RV function (all P < 0.05). RV dysfunction, but not early changes in renal function, was associated with post-discharge clinical events. Conclusions RV dysfunction is a predictor of an early but transient progression to IRF during depletive therapy. RV dysfunction modifies the individual impact of various hemodynamic variables on the early trajectory of renal function in ADHF.

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“…Several markers of the high pressures associated with this congestive process have been proposed including the assessment of large veins (vena cava, internal jugular) as well as detecting abnormal venous waveforms suggestive that the limit of the systemic venous compliance in the portal vein, hepatic veins and intra-renal veins [17]. All of these markers have been associated with adverse consequences of venous hypertension, both in acute and chronic settings [18][19][20][21]. However, they also all have significant limitations that may hamper their clinical usefulness when interpreted in isolation [22][23][24].…”

Section: Introductionmentioning

confidence: 99%

Quantifying systemic congestion with Point-Of-Care ultrasound: development of the venous excess ultrasound grading system

Rola²,

et al. 2020

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Background: Organ congestion is a mediator of adverse outcomes in critically ill patients. Point-Of-Care ultrasound (POCUS) is widely available and could enable clinicians to detect signs of venous congestion at the bedside. The aim of this study was to develop several grading system prototypes using POCUS and to determine their respective ability to predict acute kidney injury (AKI) after cardiac surgery. This is a post-hoc analysis of a single-center prospective study in 145 patients undergoing cardiac surgery for which repeated daily measurements of hepatic, portal, intra-renal vein Doppler and inferior vena cava (IVC) ultrasound were performed during the first 72 h after surgery. Five prototypes of venous excess ultrasound (VExUS) grading system combining multiple ultrasound markers were developed. Results: The association between each score and AKI was assessed using time-dependant Cox models as well as conventional performance measures of diagnostic testing. A total of 706 ultrasound assessments were analyzed. We found that defining severe venous congestion as the presence of severe flow abnormalities in multiple Doppler patterns with a dilated IVC (≥ 2 cm) showed the strongest association with the development of subsequent AKI compared with other combinations (HR: 3.69 CI 1.65-8.24 p = 0.001). The association remained significant after adjustment for baseline risk of AKI and vasopressor/inotropic support (HR: 2.82 CI 1.21-6.55 p = 0.02). Furthermore, this severe VExUS grade offered a useful positive likelihood ratio (+LR: 6.37 CI 2.19-18.50) when detected at ICU admission, which outperformed central venous pressure measurements. Conclusions: The combination of multiple POCUS markers may identify clinically significant venous congestion.

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Portal congestion and intestinal edema in hospitalized patients with heart failure

Cited by 40 publications

References 41 publications

The Role of Point-of-Care Ultrasound Monitoring in Cardiac Surgical Patients With Acute Kidney Injury

The Role of Point-of-Care Ultrasound Monitoring in Cardiac Surgical Patients With Acute Kidney Injury

Impacts of right ventricular function and venous congestion on renal response during depletion in acute heart failure

Quantifying systemic congestion with Point-Of-Care ultrasound: development of the venous excess ultrasound grading system

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