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

Abstract

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.

Whole body ultrasound in the operating room and intensive care unit

“…12). The pattern of the interlobar vein Doppler signal is affected by central venous compliance [51,52]. A normal venous pattern is continuous (Fig.…”

“…Those patients (Fig. 12E) will experience a rapid decrease in glomerular filtration rate [18,19,52] and a higher risk of death [51] (Fig. 12).…”

“…AKI: acute kidney injury, IVC: infe rior vena cava, RV: right ventricle. Adap ted from Beaubien-Souligny et al [52].…”

Dialysis-Induced Cardiovascular and Multiorgan Morbidity

“…However, no studies have explored the effect of ultrafiltration feedback control on patient outcomes. 155,161,162 In addition, these "intelligent" systems should be used with caution, and some researchers advocate cross-checking with other technologies (e.g., bioimpedance) to prevent exposing the patient to chronic fluid overload. 163 Other studies have suggested that sodium and ultrafiltration profiling may partly preserve intradialytic hemodynamic status, but sodium profiling may aggravate intradialytic salt loading, resulting in thirst and high interdialytic weight gain with chronic fluid overload.…”

Perioperative Echocardiography During the Coronavirus Crisis: Considerations in Pediatrics and Congenital Heart Disease

“…Echocardiographic examinations may be possible at the point-of-care by the clinicians already taking care of these children with suspected or proven coronavirus infection. [18][19] This approach is advantageous not only for patient convenience but also for infection control. The final location for an echocardiographic examination will often require thoughtful consideration of the following factors: risk of viral transmission, including pregnant women; monitoring capabilities; and, staffing requirements.…”