Comprehensive Assessment of Fluid Status by Point-of-Care Ultrasonography

Abstract

The management of complex fluid and electrolyte disorders is central to the practice of nephrologists. The sensitivity of physical examination alone to determine fluid status is limited, precluding accurate clinical decision making. Point-of-Care Ultrasonography (POCUS) is emerging as a valuable non-invasive bedside diagnostic tool for objective evaluation of physiological and hemodynamic parameters related to fluid status, tolerance, and responsiveness. Rapid bedside sonographic evaluation can obtain qualitative data on cardiac function as well as quantitative data on pulmonary congestion. Advanced POCUS, including goal-directed Doppler echocardiography provides additional quantitative information including flow velocities and pressures across the cardiac structures. Recently, abnormal Doppler flow patterns in abdominal organs secondary to increased right atrial pressure have been linked to congestive organ damage adding another component to the hemodynamic assessment. Integrating POCUS findings with clinical and laboratory data can further elucidate a patient's hemodynamic status. This drives decisions regarding crystalloid administration or, conversely, diuresis or ultrafiltration and allows tailored therapy for individual patients. In this article, we provide an overview of the focused assessment of cardiovascular function, pulmonary and venous congestion using POCUS and review relevant literature.

Venous Excess Doppler Ultrasound for the Nephrologist: Pearls and Pitfalls

“…Doppler ultrasound of the systemic veins adds another data point in the evaluation of bedside hemodynamic status and constitutes a piece of the puzzle, together with clinical, laboratory, and other sonographic parameters. 22 , 44 Future studies are needed to evaluate how to better integrate VExUS into clinical care and the impact of such an approach on measurable outcomes. Several clinical trials testing this protocol in diverse patient groups are in progress, and are expected to shed light on some of the unknowns.…”

“…In addition to quantification of congestion and prognostic significance, serial monitoring of these waveforms provides a real-time appraisal of the efficacy of decongestive therapy, as reported in multiple case studies. 39 , 40 , 41 , 42 , 43 , 44 , 45 Following are 2 case examples from our practice.…”

Venous congestion on the VExUS scale in patients with decompensated heart failure

“…В последнее время разрабатываются новые ультразвуковые методы оценки статуса гидратации у пациентов с ДХСН в сочетании с общепринятыми клинико-лабораторными методами. Для выбора тактики введения пациентов с ДХСН важное значение имеет комплексное исследование сердца, вен брюшной полости и легких [1]. В клинических исследованиях для выявления венозного застоя у пациентов с ХСН оценивали систолическую и диастолическую функцию левого желудочка и состояние легких и нижней полой вены (НПВ) с помощью ультразвукового метода [2][3][4], однако возможность оценки венозного застоя у больных с ДХСН изучалась в единичных исследованиях [5][6][7].…”

Hospital at home for acute medical illness: The 21st century acute medical unit for a changing population

“…• Dementia (n =1) diuretic therapy [69] and predict readmission in heart failure [70]. POCUS can be used to exclude renal tract obstruction in patients with kidney injury [71] and more advanced methods allow the quantification of systemic venous congestion and visceral edema allowing renal injury to be predicted in advance [72,73]. POCUS can be used to detect optic disc swelling in conditions associated with raised intracranial pressure [74].…”