Accuracy of cumulative volumes of fluid challenge to assess fluid responsiveness in critically ill patients with acute circulatory failure: a pharmacodynamic approach

AbstractBackground:Acute kidney injury (AKI) is associated with significant morbidity and mortality, particularly in unstable critically ill patients. In this context, serum creatinine concentration is an imperfect tool for estimating glomerular filtration rate (GFR), an index of renal function. The objective of this pilot study was to evaluate the feasibility of measuring iohexol clearance for GFR assessment in critically ill patients with acute circulatory failure at intensive care unit (ICU) admission.Methods:ICU patients were prospectively included within 12 h of acute circulatory failure; a non-toxic dose of iohexol (5 mL) was infused intravenously and iohexol plasma concentration decrease was measured over 24 h. Urinary iohexol concentration was measured in urine samples collected four times, every 6 h for 24 h. The Kidney Disease Improving Global Outcome score, measuring AKI, was calculated each day.Results:Among 18 patients with acute circulatory failure, AKI developed in 15; 14 showed decreased serum creatinine concentration during the first 24 h even though 10 presented AKI. The absolute variation in serum creatinine concentration was correlated with fluid balance over 24 h. Median [min; max] plasma clearance of iohexol was 39.4 mL/min [6.1; 154.0] and iohexol urinary clearance 32.8 mL/min [0.8–170.4]. The correlation between plasma and urinary clearance was ρ=0.97, p<0.0001.Conclusions:GFR may be estimated by plasma iohexol clearance in unstable critically ill patients. This method is reliable, correlates very well with urinary iohexol clearance and does not depend on input/output fluid balance and fluid infusion, as compared with serum creatinine concentration.

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Efficacy of Fluid Administration Followed by Lung Sonography in Hemodynamic Assessment in Acute Circulatory Failure in Critically Ill Patients

Journal of Advances in Medicine and Medical Research ◽

10.9734/jammr/2020/v32i1430558 ◽

2020 ◽

pp. 1-9

Author(s):

Ahmed M. Elkashef ◽

Mohamad G. Elmawy ◽

Mohamed A. Eltomey ◽

Ashraf E. Elzeftawy ◽

Ahmed M. Hamed

Keyword(s):

Intensive Care ◽

Critically Ill ◽

Critically Ill Patients ◽

Fluid Administration ◽

Circulatory Failure ◽

Acute Circulatory Failure ◽

Lung Sonography ◽

Group I ◽

Significant Difference ◽

Group Ii

Background: Early recognition and appropriate treatment of shock have been shown to decrease mortality. Incorporation of bedside ultrasound in patients with undiﬀerentiated shock allows for rapid evaluation of reversible causes of shock and improves accurate diagnosis in undiﬀerentiated hypotension. The aim of the present study was to evaluate efficacy of fluid administration followed by lung sonography in hemodynamic assessment in acute circulatory failure in critically ill patients. Materials and Methods: This prospective cohort controlled randomized study was carried out on 50 Critically ill Patients who had acute circulatory failure in intensive care unit Tanta university hospital Critically ill patients of either sex aged 21-60 years when mean blood pressure was below 65 mmHg were included. Patients have been uniformly distributed in 2 categories, The patients assigned either to the Control Group (group I) or to the FALLS (fluid administration limited by lung sonography) protocol group (group II). Results: Comparison between two groups revealed that, the heart rate showed that heart rate is lower in group II in comparison to group I .Comparison between two groups revealed that, the mean arterial blood pressure changes showed that it is higher in group II in comparison to group I .Comparison between two groups revealed that, the Central venous pressure showed that no significant difference in the base line .Intensive care unit stay in group I ranged between 5 – 11 days while in group II ranged between 3 – 8 days .Survival analysis (Kaplan Mier curve), Mortality at 28 days found in group I mean 21.28 days with SE 1.898 and in group II mean 24 days with SE 1.64 with no significant difference in time but there was significant difference in number of mortalities as discussed before. Conclusion: We conclude from this study that bedside Lung Ultrasound has a good accuracy and superiority in assessment over other traditionally used methods for detecting early signs of pulmonary congestion and thus guides the fluid administration in shock management to decrease complications, mortality and intensive care stay.

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Procalcitonin (PCT) is useful in predicting the bacterial origin of an acute circulatory failure in critically ill patients

Intensive Care Medicine ◽

10.1007/bf02900729 ◽

2000 ◽

Vol 26 (2) ◽

pp. S153-S158 ◽

Cited By ~ 19

Author(s):

C. Cheval ◽

J. F. Timsit ◽

M. Garrouste-Orgeas ◽

M. Assicot ◽

B. De Jonghe ◽

...

Keyword(s):

Critically Ill ◽

Critically Ill Patients ◽

Circulatory Failure ◽

Acute Circulatory Failure ◽

Bacterial Origin

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Plethysmographic variability index as a tool to assess fluid responsiveness in critically ill patients: a correlation study with inferior vena cava distensibility index

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20195535 ◽

2019 ◽

Vol 7 (12) ◽

pp. 4663

Author(s):

Parvinder Singh Bedi ◽

Bhavna Pahwa ◽

Bhavna Hooda ◽

Deepak Dwivedi

Keyword(s):

Inferior Vena Cava ◽

Critically Ill ◽

Fluid Responsiveness ◽

Critically Ill Patients ◽

Inferior Vena ◽

Vena Cava ◽

Fluid Challenge ◽

Time Points ◽

Variability Index ◽

Plethysmographic Variability Index

Background: In critically ill patients in the intensive care unit (ICU), early aggressive fluid replacement is the cornerstone of resuscitation. Traditionally employed static measures of fluid responsiveness have a poor predictive value. It is therefore imperative to employ dynamic measures of fluid responsiveness that take into account the heart lung interactions in the mechanically ventilated patients. The main objective of this study was to evaluate the reliability of one such non-invasive dynamic index: Plethysmographic variability index (PVI) compared to the widely employed Inferior vena cava distensibility index (dIVC).Methods: Seventy-six adult patients admitted at a tertiary care mixed ICU, who developed hypotension (MAP<65mmHg), were included in the study. PVI was recorded using the MASIMO-7 monitor and dIVC measurements done using Terason ultrasound. Based on the dIVC measurement threshold of 18%, the patients were classified into volume responders and non-responders. The hemodynamic, PVI and dIVC measurements were recorded at pre specified time points following a fluid challenge of 20 ml/kg crystalloid infusion.Results: Baseline PVI values were significantly higher in the responders (22.3±8.2) compared to non-responders (10.1±2.9) (p<0.001) and showed a declining trend at all time points in the responders. Similar declining trend was observed in the dIVC measurements. Overall, the Pearson correlation graph showed strong correlation between dIVC and PVI values at all time points (r=0.678, p=0.001). The ROC curve between the dIVC and PVI values revealed that Baseline PVI (Pre PVI) >15.5% discriminated between responders and non-responders with a 90.2% sensitivity and 75% specificity with an AUC of 0.84 (0.72-0.96) (p<0.001).Conclusions: There is good correlation between PVI values and measured dIVC values at baseline and following a fluid challenge. Thus, PVI may be an acceptable, real time, continuous, surrogate measure of fluid responsiveness in critically ill patients.

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