Ask not liberal or conservative intravenous fluids in septic shock: ask rather why and when

Kenny, Jon‐Émile S.

doi:10.1186/s13049-022-01054-w

Cited by 1 publication

(1 citation statement)

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“…In early sepsis and septic shock, a clinically significant proportion of patients receiving IV fluids do not exhibit SV augmentation and, as resuscitation progresses, more than 90% of patients cease having the anticipated SV-enhancing effect of a crystalloid infusion [ 6 – 8 ]. Importantly, withholding IV fluids in patients who fail to have the desired physiological effect is not harmful [ 6 ].…”

Section: Introductionmentioning

confidence: 99%

Simultaneous venous–arterial Doppler during preload augmentation: illustrating the Doppler Starling curve

Kenny

Gibbs²,

Eibl

et al. 2023

Ultrasound J

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Providing intravenous (IV) fluids to a patient with signs or symptoms of hypoperfusion is common. However, evaluating the IV fluid ‘dose–response’ curve of the heart is elusive. Two patients were studied in the emergency department with a wireless, wearable Doppler ultrasound system. Change in the common carotid arterial and internal jugular Doppler spectrograms were simultaneously obtained as surrogates of left ventricular stroke volume (SV) and central venous pressure (CVP), respectively. Both patients initially had low CVP jugular venous Doppler spectrograms. With preload augmentation, only one patient had arterial Doppler measures indicative of significant SV augmentation (i.e., ‘fluid responsive’). The other patient manifested diminishing arterial response, suggesting depressed SV (i.e., ‘fluid unresponsive’) with evidence of ventricular asynchrony. In this short communication, we describe how a wireless, wearable Doppler ultrasound simultaneously tracks surrogates of cardiac preload and output within a ‘Doppler Starling curve’ framework; implications for IV fluid dosing are discussed.

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Section: Introductionmentioning

confidence: 99%