Use of bedside ultrasound to assess fluid status: a literature review

Piotrkowski, Jakub; Buda, Natalia; Januszko‐Giergielewicz, Beata; Kosiak, Wojciech

doi:10.20452/pamw.14962

Cited by 9 publications

(14 citation statements)

References 37 publications

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“…Promisingly, Doppler can also be used to determine overload or congestion. Ultrasound data from numerous organs such as the lungs, heart, inferior vena cava (IVC), internal jugular vein, and hepatic vein can be obtained very quickly to assist doctors in assessing the fluid status and making fluid management decisions ( Piotrkowski et al, 2019 ; Elhassan et al, 2021 ; Koratala, 2021 ). Apart from the RRI obtained from intrarenal artery Doppler, intrarenal vein Doppler (IRVD) incorporates novel clinical markers, such as the venous impedance index (VII), intrarenal venous flow (IRVF), or renal venous stasis index (RVSI), which provide new insight into evaluating renal congestion or overload, diagnosing renal disease, and guiding volume management in patients with heart failure.…”

Section: Intrarenal Doppler In Assessing Renal Veinsmentioning

confidence: 99%

Intrarenal Doppler approaches in hemodynamics: A major application in critical care

et al. 2022

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The treatment of severe cases usually requires multimodality hemodynamic monitoring approaches, particularly for tissue and organ perfusion tracking. Currently, only a few studies have investigated renal perfusion status at the bedside. Ultrasound has become increasingly utilized to guide the hemodynamic management of severe patients. Similarly, intrarenal Doppler (IRD) is widely used to assess renal perfusion from both the intrarenal artery and vein perspectives. The renal resistive index (RRI), which reflects the renal arterial blood flow profile, is often applied to predict the reversibility of renal dysfunction and to titrate hemodynamic support. Intrarenal venous flow (IRVF) patterns and the renal venous stasis index (RVSI), which reflects the intrarenal vein blood flow profile, are now being used to assess intravenous congestion. They may also be useful in predicting the risk of acute kidney injury and avoiding fluid overload. IRD can provide diverse and supplemental information on renal perfusion and may help to establish the early diagnosis in severe patients. This review focused on the specific operational methods, influencing factors, and applications of IRD in hemodynamics.

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Section: Intrarenal Doppler In Assessing Renal Veinsmentioning

confidence: 99%

Intrarenal Doppler approaches in hemodynamics: A major application in critical care

et al. 2022

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“…IVC/Ao index ≤ 0.8 indicates fluid responsiveness [15]. Lung ≥ 3 B-lines bilaterally indicates pulmonary edema [24]. Heart LVEDA <10 cm 2 indicates hypovolemia and ≥ 20 cm 2 suggests hypervolemia [24,26].…”

Section: Assessments Sonographic Indicatorsmentioning

confidence: 99%

“…Lung ≥ 3 B-lines bilaterally indicates pulmonary edema [24]. Heart LVEDA <10 cm 2 indicates hypovolemia and ≥ 20 cm 2 suggests hypervolemia [24,26]. LVOT VTI > 12-15% increase after passive leg raising to predict fluid responsiveness [31].…”

Section: Assessments Sonographic Indicatorsmentioning

confidence: 99%

Ultrasound in postresuscitation care: a narrative review

Hsu

Chen

Lee

et al. 2022

European Journal of Emergency Medicine

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The efficacy of ultrasound (US) in real-time differential diagnosis and guiding further treatment decisions has been well demonstrated in prearrest conditions and during resuscitation. Evidence is limited regarding the application of US in postresuscitation care. Most of the patients following resuscitation remain comatose, and the requirement for transportation to other examination rooms increases their risk of injury. US can be performed at the bedside with high accessibility and timeliness without radiation. This narrative review provides an overview of current evidence regarding the application of US in identifying the cause of cardiac arrest (CA), hemodynamic monitoring, and prognostication in postresuscitation care. For identifying the cause of CA, cardiac US is mainly used to detect regional wall motion abnormality. However, postarrest myocardial dysfunction would confound the sonographic findings that a combination of electrocardiograms and biomarkers besides the cardiac US could improve the positive predictive value of coronary artery disease. For hemodynamic monitoring, left ventricular outlet tract velocity time integral has the best performance in predicting fluid responsiveness in conjunction with the passive leg raising test. The RUSH protocol assists in determining the subtypes of shock with high sensitivity and specificity in hypovolemic, cardiogenic, or obstructive shock. Evidence regarding the application of US for prognostication is still limited, and further evaluation should be needed.

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“…As the access to US technology and training becomes better, the evidence is growing on the use of POCUS in hydration status assessment, IVF administration guidance and rehydration responsiveness 24 25. Clinical practice in childhood AGE is not homogeneous, so a tool to accurately estimate the amount of fluids needed to rehydrate a patient is desired 26.…”

Section: Discussionmentioning

confidence: 99%

Point-of-care ultrasound to assess degree of dehydration in children: a systematic review with meta-analysis

2023

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BackgroundThere is no perfect method to assess level of dehydration in children. There are studies with conflicting results, where point-of-care ultrasound (POCUS) measurement of diameter ratio of the inferior vena cava to the aorta (IVC/Ao) was used to predict degree of dehydration.ObjectiveTo systematically review the diagnostic accuracy of POCUS measurement of IVC/Ao ratio in predicting dehydration in children.MethodsMEDLINE, EMBASE and Cochrane databases were searched. The primary outcome was the diagnostic accuracy of IVC/Ao ratio. The pooled sensitivity and specificity were calculated. Quality analysis was conducted using Quality Assessment of Diagnostic Accuracy Studies-2.ResultsEleven studies (2679 patients) were included. The most numerous group (five studies) used percentage weight change as a reference standard; the pooled sensitivity, specificity of POCUS in this group were: 0.7 (95% CI: 0.67 to 0.73), I2: 82%; 0.53 (95% CI: 0.5 to 0.53), I2: 84%. In the remaining studies, different comparator tests were used: Clinical Dehydration Scale (two studies, 0.8 (95% CI: 0.72 to 0.86), I2: 0%; 0.56 (95% CI: 0.48 to 0.65), I2: 0%; clinical judgement (three studies, 0.78 (95% CI: 0.73 to 0.83), I2: 95%; 0.82 (95% CI: 0.77 to 0.86), I2: 93% and one study used the Dehydration: Assessing Kids Accurately score model.ConclusionThis systematic review and meta-analysis showed that POCUS has a moderate sensitivity and specificity for identifying dehydration in children. Its use as a complementary diagnostic tool could be promising but needs to be validated in randomised controlled trials.PROSPERO registration numberCRD42022346166.

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Use of bedside ultrasound to assess fluid status: a literature review

Cited by 9 publications

References 37 publications

Intrarenal Doppler approaches in hemodynamics: A major application in critical care

Intrarenal Doppler approaches in hemodynamics: A major application in critical care

Ultrasound in postresuscitation care: a narrative review

Point-of-care ultrasound to assess degree of dehydration in children: a systematic review with meta-analysis

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