Development of a fluid resuscitation protocol using inferior vena cava and lung ultrasound

Lee, Christopher W.C.; Kory, Pierre; Arntfield, Robert

doi:10.1016/j.jcrc.2015.09.016

Cited by 73 publications

(54 citation statements)

References 37 publications

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“…Most recent studies have reported that the effectiveness of bedside multi-organ point-of-care ultrasound in undifferentiated shock by using IVC size and respiratory variation as an indicator for fluid resuscitation [9–11, 13, 15]. Using information from lung and IVC ultrasound, physician can embark on a treatment plan, and be guided subsequently by cardiac ultrasound [21]. Most ultrasound guided resuscitation protocols are designed to evaluate patients with hypotension or dyspnea using basic cardiovascular and lung ultrasound findings [1, 2, 10, 13, 14, 16, 19, 20].…”

Section: Discussionmentioning

confidence: 99%

SEARCH 8Es: A novel point of care ultrasound protocol for patients with chest pain, dyspnea or symptomatic hypotension in the emergency department

et al. 2017

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ObjectiveThis study was conducted to evaluate a problem-oriented focused torso bedside ultrasound protocol termed “Sonographic Evaluation of Aetiology for Respiratory difficulty, Chest pain, and/or Hypotension” (SEARCH 8Es) for its ability to narrow differential diagnoses and increase physicians’ diagnostic confidence, and its diagnostic accuracy, for patients presenting with dyspnea, chest pain, or symptomatic hypotension.MethodsThis single-center prospective observational study was conducted over 12 months in an emergency department and included 308 patients (184 men and 124 women; mean age, 67.7 ± 19.1 years) with emergent cardiopulmonary symptoms. The paired t-test was used to compare the number of differential diagnoses and physician’s level of confidence before and after SEARCH 8Es. The overall accuracy of the SEARCH 8Es protocol in differentiating 13 diagnostic entities was evaluated based on concordance (kappa coefficient) with the diagnosis made by the inpatient specialists. Sensitivity, specificity, positive predictive value, and negative predictive value were calculated.ResultsSEARCH 8Es narrows the number of differential diagnoses (2.5 ± 1.5 vs. 1.4 ± 0.7; p < 0.001) and improves physicians’ diagnostic confidence (2.8 ± 0.8 vs. 4.3 ± 0.9; p < 0.001) significantly. The overall kappa coefficient value was 0.870 (p < 0.001), with the overall sensitivity, specificity, positive predictive value, and negative predictive value at 90.9%, 99.0%, 89.7%, and 99.0%, respectively.ConclusionThe SEARCH 8Es protocol helps emergency physicians to narrow the differential diagnoses, increase diagnostic confidence and provide accurate assessment of patients with dyspnea, chest pain, or symptomatic hypotension.

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Section: Discussionmentioning

confidence: 99%

SEARCH 8Es: A novel point of care ultrasound protocol for patients with chest pain, dyspnea or symptomatic hypotension in the emergency department

et al. 2017

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“…Other data from studies in trauma patients suggest that the aorta to IVC ratios may be a more reliable measure of hypovolemia [132]. Dynamic evaluation of the IVC in conjunction with thoracic ultrasound can help with assessing fluid responsiveness for patients in shock [133]. …”

Section: Diagnostic Applications Of Ultrasoundmentioning

confidence: 99%

Pediatric emergency medicine point-of-care ultrasound: summary of the evidence

et al. 2016

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The utility of point-of-care ultrasound is well supported by the medical literature. Consequently, pediatric emergency medicine providers have embraced this technology in everyday practice. Recently, the American Academy of Pediatrics published a policy statement endorsing the use of point-of-care ultrasound by pediatric emergency medicine providers. To date, there is no standard guideline for the practice of point-of-care ultrasound for this specialty. This document serves as an initial step in the detailed “how to” and description of individual point-of-care ultrasound examinations. Pediatric emergency medicine providers should refer to this paper as reference for published research, objectives for learners, and standardized reporting guidelines.

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“…This will be reflected in an SV reading of <12% indicating another intervention such as inotrope or vasopressor may be selected other than volume. [2528]…”

Section: Discussionmentioning

confidence: 99%

“…Recently, the use of point-of-care ultrasound (POCS) has been proposed as viable simple and less invasive tool to guide fluid. [28] The validity of the POCS fluid responsiveness guide, however, requires further study to comparing results obtained from various other dynamic methods to further validate the POCS benefits and limitations.…”

Section: Discussionmentioning

confidence: 99%

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Passive leg raising: Simple and reliable technique to prevent fluid overload in critically ill patients

Assadi

2017

Int J Prev Med

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Background:Dynamic measures, the response to stroke volume (SV) to fluid loading, have been used successfully to guide fluid management decisions in critically ill patients. However, application of dynamic measures is often inaccurate to predict fluid responsiveness in patients with arrhythmias, ventricular dysfunction or spontaneously breathing critically ill patients. Passive leg raising (PLR) is a simple bedside maneuver that may provide an accurate alternative to guide fluid resuscitation in hypovolemic critically ill patients.Methods:Pertinent medical literature for fluid responsiveness in the critically ill patient published in English was searched over the past three decades, and then the search was extended as linked citations indicated.Results:Thirty-three studies including observational studies, randomized control trials, systemic review, and meta-analysis studies evaluating fluid responsiveness in the critically ill patient met selection criteria.Conclusions:PLR coupled with real-time SV monitors is considered a simple, noninvasive, and accurate method to determine fluid responsiveness in critically ill patients with high sensitivity and specificity for a 10% increase in SV. The adverse effect of albumin on the mortality of head trauma patients and chloride-rich crystalloids on mortality and kidney function needs to be considered when choosing the type of fluid for resuscitation.

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Development of a fluid resuscitation protocol using inferior vena cava and lung ultrasound

Cited by 73 publications

References 37 publications

SEARCH 8Es: A novel point of care ultrasound protocol for patients with chest pain, dyspnea or symptomatic hypotension in the emergency department

SEARCH 8Es: A novel point of care ultrasound protocol for patients with chest pain, dyspnea or symptomatic hypotension in the emergency department

Pediatric emergency medicine point-of-care ultrasound: summary of the evidence

Passive leg raising: Simple and reliable technique to prevent fluid overload in critically ill patients

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