Risks and Benefits of Fluid Administration as Assessed by Ultrasound

Millington, Scott J.; Wiskar, Katie; Hobbs, Hailey; Koenig, Seth

doi:10.1016/j.chest.2021.06.041

Cited by 10 publications

(3 citation statements)

References 38 publications

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“…If the distance travelled by blood (i.e., in cm) is multiplied by the cross-sectional area of the vessel in which the blood moves (i.e., in cm 2 ), the result is volume (i.e., cm 3 ); at the left ventricular outflow tract (LVOT), this calculation confers SV( Figure 2 ) [ 45 , 46 ]. Quantifiable change in SV is a powerful tool when making therapeutic decisions, especially with respect to IV fluids [ 47 ].…”

Section: Doppler Ultrasoundmentioning

confidence: 99%

“…Though not specified above, fluid responsiveness is defined by an increase in stroke volume (or cardiac output) of 10–15%, with the provision of IV fluids [ 69 ]. Whereas fluid responsiveness has a consistent, quantitative definition, fluid tolerance is more qualitative and unformulated [ 47 ]. The concept of fluid tolerance has arisen in step with whole-body ultrasonography and the increasingly recognized stigmata of excessive IV fluid when scanning different organ systems [ 70 ].…”

Section: Advanced Critical Care Echocardiography With Spectral Dopple...mentioning

confidence: 99%

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Assessing Fluid Intolerance with Doppler Ultrasonography: A Physiological Framework

Kenny

2022

Medical Sciences

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Ultrasonography is becoming the favored hemodynamic monitoring utensil of emergentologists, anesthesiologists and intensivists. While the roles of ultrasound grow and evolve, many clinical applications of ultrasound stem from qualitative, image-based protocols, especially for diagnosing and managing circulatory failure. Often, these algorithms imply or suggest treatment. For example, intravenous fluids are opted for or against based upon ultrasonographic signs of preload and estimation of the left ventricular ejection fraction. Though appealing, image-based algorithms skirt some foundational tenets of cardiac physiology; namely, (1) the relationship between cardiac filling and stroke volume varies considerably in the critically ill, (2) the correlation between cardiac filling and total vascular volume is poor and (3) the ejection fraction is not purely an appraisal of cardiac function but rather a measure of coupling between the ventricle and the arterial load. Therefore, management decisions could be enhanced by quantitative approaches, enabled by Doppler ultrasonography. Both fluid ‘responsiveness’ and ‘tolerance’ are evaluated by Doppler ultrasound, but the physiological relationship between these constructs is nebulous. Accordingly, it is argued that the link between them is founded upon the Frank–Starling–Sarnoff relationship and that this framework helps direct future ultrasound protocols, explains seemingly discordant findings and steers new routes of enquiry.

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Section: Doppler Ultrasoundmentioning

confidence: 99%

Section: Advanced Critical Care Echocardiography With Spectral Dopple...mentioning

confidence: 99%

Assessing Fluid Intolerance with Doppler Ultrasonography: A Physiological Framework

Kenny

2022

Medical Sciences

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“…Unlike fluid responsiveness, defined as improved cardiac output in response to volume loading ( 13 ), fluid tolerance seeks to identify patients at risk of end-organ dysfunction and venous congestion from over-resuscitation ( 14 ). Although there is no universally agreed-upon definition of sonographic findings for fluid tolerance, prior studies have suggested systolic and diastolic dysfunction ( 14 ) and IVC dilation with lack of respiratory variation as resuscitation endpoints ( 7 ).…”

mentioning

confidence: 99%

Focused Cardiac Ultrasound Findings of Fluid Tolerance and Fluid Resuscitation in Septic Shock

Prevalska,

Tucker,

England

et al. 2023

Critical Care Explorations

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OBJECTIVES: Compliance with the fluid bonus component of the SEP-1 (severe sepsis and septic shock management) bundle remains poor due to concerns for iatrogenic harm from fluid overload. We sought to assess whether patients who received focused cardiac ultrasound (FCU) and were found to be fluid tolerant (FT) were more likely to receive the recommended 30 mL/kg fluid bolus within 3 hours of sepsis identification. DESIGN: Retrospective, observational cohort study. SETTING: University-affiliated, tertiary-care hospital in the United States. PATIENTS: Emergency department patients presenting with septic shock from 2018 to 2021. The primary exposure was receipt of FCU with identification of fluid tolerance 3 hours from onset of septic shock. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Two hundred ninety-two of 1,024 patients with septic shock received FCU within 3 hours of sepsis onset. One hundred seventy-seven were determined to be FT. One hundred fifteen patients were determined to have poor fluid tolerance (pFT). FT patients were more likely to reach the recommended 30 mL/kg fluid bolus amount compared with pFT (FT 52.0% vs. pFT 31.3%, risk difference: 20.7%, [95% CI, 9.4–31.9]). Patients who did not receive FCU met the bolus requirement 34.3% of the time. FT patients received more fluid within 3 hours (FT 2,271 mL vs. pFT 1,646 mL, mean difference 625 mL [95% CI, 330–919]). Multivariable logistic regression was used to estimate the association between fluid tolerance FCU findings and compliance with 30 mL/kg bolus after adjustment for patient characteristics and markers of hemodynamic instability. FT with associated with a higher likelihood of meeting bolus requirement (odds ratio 2.17 [1.52–3.12]). CONCLUSIONS: Patients found to be FT by FCU were more likely to receive the recommended 30 mL/kg bolus in the SEP-1 bundle when compared with patients found with pFT or those that did not receive FCU. There was no difference between groups in 28-day mortality, vasopressor requirement, or need for mechanical ventilation.

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The role of point-of-care ultrasound to monitor response of fluid replacement therapy in pregnancy

Gevaerd Martins,

Saad,

Saade

et al. 2024

American Journal of Obstetrics and Gynecology

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Risks and Benefits of Fluid Administration as Assessed by Ultrasound

Cited by 10 publications

References 38 publications

Assessing Fluid Intolerance with Doppler Ultrasonography: A Physiological Framework

Assessing Fluid Intolerance with Doppler Ultrasonography: A Physiological Framework

Focused Cardiac Ultrasound Findings of Fluid Tolerance and Fluid Resuscitation in Septic Shock

The role of point-of-care ultrasound to monitor response of fluid replacement therapy in pregnancy

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