Diagnosis of Fluid Overload: From Conventional to Contemporary Concepts

Koratala, Abhilash; Ronco, Claudio; Kazory, Amir

doi:10.1159/000526902

Cited by 35 publications

(47 citation statements)

References 115 publications

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“…Physical examination, including assessment of jugular venous pressure, lower extremity edema, presence of an ‘S3’, and auscultation of the lungs for evidence of pulmonary edema, has traditionally been a common way for clinicians to assess intravascular volume status at the bedside. This is wrought with subjectivity and inaccuracies, and has almost no correlation with right heart catheterization, which is the invasive gold-standard assessment[ 10 , 11 ]. Similarly, chest X-ray remains a common modality to diagnose pulmonary congestion resulting from heart failure or other etiologies, despite having considerable diagnostic limitations including high false negative rate[ 12 ].…”

Section: Conventional Methods To Assess Congestionmentioning

confidence: 99%

Point-of-care ultrasound in diagnosis and management of congestive nephropathy

Turk¹,

Robertson²,

Koratala³

2023

World J Crit Care Med

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Congestive nephropathy is kidney dysfunction caused by the impact of elevated venous pressures on renal hemodynamics. As a part of cardiorenal syndrome, the diagnosis is usually made based on history and physical examination, with findings such as jugular venous distension, a third heart sound, and vital signs as supporting findings. More recently, however, these once though objective measures have come under scrutiny for their accuracy. At the same time, bedside ultrasound has increased in popularity and is routinely being used by clinicians to take some of the guess work out of making the diagnosis of volume overload and venous congestion. In this mini-review, we will discuss some of the traditional methods used to measure venous congestion, describe the role of point-of-care ultrasound and how it can ameliorate a clinician’s evaluation, and offer a description of venous excess ultrasound score, a relatively novel scoring technique used to objectively quantify congestion. While there is a paucity of published large scale clinical trials evaluating the potential benefit of ultrasonography in venous congestion compared to gold standard invasive measurements, more study is underway to solidify the role of this objective measure in daily clinical practice.

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Section: Conventional Methods To Assess Congestionmentioning

confidence: 99%

Point-of-care ultrasound in diagnosis and management of congestive nephropathy

Turk¹,

Robertson²,

Koratala³

2023

World J Crit Care Med

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“…This can lead to a vicious cycle of edema leading to increased tissue pressure, which raises the P CC , increasing the retrograde venous pressure. Dr Koratala and colleagues [16] recently compiled evidence demonstrating the negative effects of increased venous pressure and decreased perfusion pressure, including hypoxia due to pulmonary edema, altered mental status due to cerebral malperfusion, cardiorenal acute kidney injury (AKI), cholestasis and hepatic injury, cardiac strain and arrhythmia, and poor wound healing due to tissue edema, among others.…”

Section: Figurementioning

confidence: 99%

Monitoring the venous circulation: novel techniques and applications

Longino,

Martin,

Douglas

2024

Current Opinion in Critical Care

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Purpose of review Venous pressure is an often-unrecognized cause of patient morbidity. However, bedside assessment of PV is challenging. We review the clinical significance of venous pressure measurement, existing techniques, and introduce the Venous Excess Ultrasound (VExUS) Score as a novel approach using doppler ultrasound to assess venous pressure. Recent findings Studies show clear associations between elevated venous pressure and adverse outcomes in critically ill patients. Current venous pressure measurement techniques include physical examination, right heart catheterization (RHC), two-dimensional ultrasound, and a variety of labor-intensive research-focused physiological maneuvers. Each of these techniques have specific shortcomings, limiting their clinical utility. To address these gaps, Beaubien-Souligny et al. introduced the VExUS Score, a novel doppler ultrasound-based method that integrates IVC diameter with doppler measurements of the hepatic, portal, and renal veins to generate a venous congestion assesment. Studies show strong correlations between VExUS score and RHC measurements, and well as an association between VExUS score and improvement in cardiorenal acute kidney injury, diuretic response, and fluid status shifts. However, studies in noncardiac populations have been small, heterogenous, and inconclus ive. Summary Early studies evaluating the use of doppler ultrasound to assess venous congestion show promise, but further research is needed in diverse patient populations and clinical settings.

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“…Acute heart failure (HF) is an important cause of unplanned hospitalisation and is characterised by excess body water, also known as congestion 1 2. Despite being a common clinical problem, there is a lack of high-quality evidence to guide drug treatment and non-pharmacological measures 3. Restriction of oral fluid intake is commonly used as an adjunct to pharmacological therapy but its effectiveness is uncertain and may exacerbate symptoms of thirst, as suggested by the limited randomised controlled trials (RCTs), which have been conducted to date 4–6.…”

Section: Introductionmentioning

confidence: 99%

Rationale and design of the THIRST Alert feasibility study: a pragmatic, single-centre, parallel-group randomised controlled trial of an interruptive alert for oral fluid restriction in patients treated with intravenous furosemide

Chen,

Shah,

Jani

et al. 2024

BMJ Open

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IntroductionAcute heart failure (HF) is a major cause of unplanned hospitalisation characterised by excess body water. A restriction in oral fluid intake is commonly imposed on patients as an adjunct to pharmacological therapy with loop diuretics, but there is a lack of evidence from traditional randomised controlled trials (RCTs) to support the safety and effectiveness of this intervention in the acute setting.This study aims to explore the feasibility of using computer alerts within the electronic health record (EHR) system to invite clinical care teams to enrol patients into a pragmatic RCT at the time of clinical decision-making. It will additionally assess the effectiveness of using an alert to help address the clinical research question of whether oral fluid restriction is a safe and effective adjunct to pharmacological therapy for patients admitted with fluid overload.Methods and analysisTHIRST (Randomised ControlledTrial within the electronicHealth record of anInterruptive alert displaying a fluidRestrictionSuggestion in patients with the treatableTrait of congestion) Alert is a single-centre, parallel-group, open-label pragmatic RCT embedded in the EHR system that will be conducted as a feasibility study at an National Health Service (NHS) hospital in London. The clinical care team will be invited to enrol suitable patients in the study using a point-of-care alert with a target sample size of 50 patients. Enrolled patients will then be randomised to either restricted or unrestricted oral fluid intake. Two primary outcomes will be explored (1) the proportion of eligible patients enrolled in the study and (2) the mean difference in oral fluid intake between randomised groups. A series of secondary outcomes are specified to evaluate the effectiveness of the alert, adherence to the randomised treatment allocation and the quality of data generated from routine care, relevant to the outcomes of interest.Ethics and disseminationThis study was approved by Riverside Research Ethics Committee (Ref: 22/LO/0889) and will be published on completion.Trial registration numberNCT05869656.

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Diagnosis of Fluid Overload: From Conventional to Contemporary Concepts

Cited by 35 publications

References 115 publications

Point-of-care ultrasound in diagnosis and management of congestive nephropathy

Point-of-care ultrasound in diagnosis and management of congestive nephropathy

Monitoring the venous circulation: novel techniques and applications

Rationale and design of the THIRST Alert feasibility study: a pragmatic, single-centre, parallel-group randomised controlled trial of an interruptive alert for oral fluid restriction in patients treated with intravenous furosemide

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