Unifying Fluid Responsiveness and Tolerance With Physiology: A Dynamic Interpretation of the Diamond–Forrester Classification

Kenny, Jon-Émile S.; Prager, Ross; Rola, Philippe; Haycock, Korbin; Basmaji, John; Hernández, Glenn

doi:10.1097/cce.0000000000001022

Cited by 10 publications

(2 citation statements)

References 25 publications

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“…HVD has also been used as a marker of venous congestion in heart failure context with prognostic implications as well [ 38 ]. As proposed by Kenny et al, the dynamic assessment of waveform patterns (i.e., increase in D wave or reversion of S wave) through a PLR maneuver or fluid challenge could aid in identifying potential congestion [ 39 , 40 ]. Thus, HVD could be a fairly unique tool able to assess not only fluid responsiveness as seen this manuscript, but also assess fluid tolerance, which is of growing clinical importance [ 41 , 42 ].…”

Section: Discussionmentioning

confidence: 99%

Dynamic changes of hepatic vein Doppler velocities predict preload responsiveness in mechanically ventilated critically ill patients

Bruna,

Alfaro,

Muñoz

et al. 2024

ICMx

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Background Assessment of dynamic parameters to guide fluid administration is one of the mainstays of current resuscitation strategies. Each test has its own limitations, but passive leg raising (PLR) has emerged as one of the most versatile preload responsiveness tests. However, it requires real-time cardiac output (CO) measurement either through advanced monitoring devices, which are not routinely available, or echocardiography, which is not always feasible. Analysis of the hepatic vein Doppler waveform change, a simpler ultrasound-based assessment, during a dynamic test such as PLR could be useful in predicting preload responsiveness. The objective of this study was to assess the diagnostic accuracy of hepatic vein Doppler S and D-wave velocities during PLR as a predictor of preload responsiveness. Methods Prospective observational study conducted in two medical–surgical ICUs in Chile. Patients in circulatory failure and connected to controlled mechanical ventilation were included from August to December 2023. A baseline ultrasound assessment of cardiac function was performed. Then, simultaneously, ultrasound measurements of hepatic vein Doppler S and D waves and cardiac output by continuous pulse contour analysis device were performed during a PLR maneuver. Results Thirty-seven patients were analyzed. 63% of the patients were preload responsive defined by a 10% increase in CO after passive leg raising. A 20% increase in the maximum S wave velocity after PLR showed the best diagnostic accuracy with a sensitivity of 69.6% (49.1–84.4) and specificity of 92.8 (68.5–99.6) to detect preload responsiveness, with an area under curve of receiving operator characteristic (AUC–ROC) of 0.82 ± 0.07 (p = 0.001 vs. AUC–ROC of 0.5). D-wave velocities showed worse diagnostic accuracy. Conclusions Hepatic vein Doppler assessment emerges as a novel complementary technique with adequate predictive capacity to identify preload responsiveness in patients in mechanical ventilation and circulatory failure. This technique could become valuable in scenarios of basic hemodynamic monitoring and when echocardiography is not feasible. Future studies should confirm these results.

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Section: Discussionmentioning

confidence: 99%

Dynamic changes of hepatic vein Doppler velocities predict preload responsiveness in mechanically ventilated critically ill patients

Bruna,

Alfaro,

Muñoz

et al. 2024

ICMx

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“…11 Propostas futuras estão sendo aventadas para definir se o paciente com VTI acima de 18 cm se enquadrariam no padrão "quente" e inferior a 18 cm no padrão "frio", e VExUS 0 ou 1 no padrão "seco" e VExUS 2 ou 3 no padrão "úmido" de insuficiência cardíaca (Figura 2). 12 Conclusão O VExUS é uma ferramenta recente que pode auxiliar na avaliação da congestão venosa sistêmica e na tolerância à fluidoterapia. Por se tratar de um exame de fácil execução, pode ser incorporado ao uso diário do POCUS, com importante impacto diagnóstico, prognóstico e terapêutico.…”

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Como Faço Avaliação da Congestão Venosa Sistêmica: Protocolo VExUS

Salgado,

Bernardo,

Melo Netto

2024

Arq Bras Cardiol: Imagem cardiovasc.

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O uso de ferramentas não invasivas para a análise da congestão venosa sistêmica em pacientes críticos em setor de cuidados intensivos tem ganho cada vez mais adeptos para o diagnóstico, estimativa da gravidade da congestão e estimativa prognóstica. Pacientes com congestão sistêmica evoluem mais para disfunção renal comparativamente àqueles que não apresentam congestão. Nesta revisão, os autores demonstram como realizar a análise da congestão sistêmica, suas possíveis limitações e suas aplicabilidades de forma prática e objetiva.

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Optimising flow without congestion using the venous‐arterial Doppler enhanced resuscitation framework

Kenny,

Rola

2024

Australas J Ultrason Med

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IntroductionUltrasonography as a guide for intravenous (IV) fluid therapy is increasingly accepted within the spheres of acute care. Initial investigations and protocols often focused on measures of arterial flow as an objective approach for personalising organ ‘perfusion.’ More recently, and with literature associating excessive IV fluid with adverse outcomes, venous ultrasound as a measure of organ ‘congestion’ is taking hold. Yet, arterial (i.e., ‘perfusion’) and venous (i.e., ‘congestion’) Doppler ultrasound measures are often performed separately and can be time‐consuming, especially for novices.MethodsWe report a case, wherein venous and arterial Doppler were simultaneously measured using a wireless, wearable ultrasound as a means to optimise flow without congestion.ResultsBefore IV volume expansion, the patient had Doppler measures consistent with low central venous pressure (CVP) and stroke volume (SV). Following IV volume expansion, venous Doppler remained the same; however, carotid corrected flow time (ccFT) increased significantly.ConclusionA framework for venous‐arterial Doppler enhanced resuscitation (VADER) can be used to guide IV volume in patients at risk for venous congestion.

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Unifying Fluid Responsiveness and Tolerance With Physiology: A Dynamic Interpretation of the Diamond–Forrester Classification

Cited by 10 publications

References 25 publications

Dynamic changes of hepatic vein Doppler velocities predict preload responsiveness in mechanically ventilated critically ill patients

Dynamic changes of hepatic vein Doppler velocities predict preload responsiveness in mechanically ventilated critically ill patients

Como Faço Avaliação da Congestão Venosa Sistêmica: Protocolo VExUS

Optimising flow without congestion using the venous‐arterial Doppler enhanced resuscitation framework

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