scholarly journals Use of Point-of-Care Ultrasound for Evaluation of Extravascular and Intravascular Fluid Status in Pediatric Patients Maintained on Chronic Hemodialysis

2021 ◽  
pp. 1-7
Author(s):  
Orly Haskin ◽  
Yafa Falush ◽  
Miriam Davidovits ◽  
Hadas Alfandary ◽  
Shelly Levi ◽  
...  
Keyword(s):  
Clinical Assessment ◽  
Pediatric Patients ◽  
Fluid Overload ◽  
Point Of Care ◽  
Vena Cava ◽  
Chronic Hemodialysis ◽  
Point Of Care Ultrasound ◽  
Sonographic Evaluation ◽  
Fluid Status ◽  
B Lines

<b><i>Aims:</i></b> Traditional methods that use clinical parameters to determine dry weight in hemodialysis patients are inaccurate. This study aimed to compare clinical assessment of fluid status to sonographic parameters of fluid status in pediatric patients undergoing chronic hemodialysis. <b><i>Methods:</i></b> In a prospective observational study, pediatric patients maintained on chronic hemodialysis (ages 2.3–20 years) were evaluated clinically and sonographically before and after dialysis at 6 consecutive sessions. Sonographic parameters examined were number of lung B-lines as a measure of extravascular volume and inferior vena cava (IVC)/aorta ratio as a measure of intravascular volume. Clinical assessment of fluid status was compared to sonographic assessment. <b><i>Results:</i></b> Twelve patients were evaluated during 72 dialysis sessions. Sonographic parameters were significantly lower post-dialysis than pre-dialysis (B-lines number 4.5 ± 5 vs. 7.69 ± 7.46, <i>p</i> &#x3c; 0.0001; IVC/aorta ratio 0.9 ± 0.2 vs. 1.1 ± 0.2, <i>p</i> &#x3c; 0.0001, respectively). Ultrafiltration volume correlated with change in B-lines number during dialysis (<i>r</i> = 0.39, <i>p</i> &#x3c; 0.01). Percent of blood volume drop correlated with post-dialysis IVC/aorta ratio (<i>r</i> = 0.48, <i>p</i> &#x3c; 0.001). A higher percent of symptomatic episodes occurred with post-dialysis IVC/aorta ratio &#x3c;0.8 versus ≥0.8 (39.1 vs. 15.2%, <i>p</i> = 0.036). Four patients were hypertensive, a clinical parameter implying fluid overload, in only one sonographic evaluation indicated fluid overload. Eight patients were clinically determined to be euvolemic, in three of them sonographic evaluation discovered covert fluids. <b><i>Conclusion:</i></b> Bedside ultrasound is a single modality that can be used to assess both extravascular and intravascular fluid status. It may contribute to clinical decisions differentiating fluid-related versus fluid-unrelated hypertension and identifying patients with covert fluids.

scholarly journals MP53: A feasibility analysis for successful completion of IVC ultrasound in hypotensive emergency department patients

CJEM ◽  
2020 ◽  
Vol 22 (S1) ◽  
pp. S62-S62
Author(s):  
R. Dunfield ◽  
P. Ross ◽  
C. Keyes ◽  
J. Fraser ◽  
D. Lewis ◽  
...  
Keyword(s):  
Emergency Department ◽  
Point Of Care ◽  
Secondary Analysis ◽  
Vena Cava ◽  
International Study ◽  
Point Of Care Ultrasound ◽  
Standard Data ◽  
Fluid Status ◽  
Emergency Department Patients ◽  
Collection Form

Introduction: Determining fluid status prior to resuscitation provides a more accurate guide for appropriate fluid administration in the setting of undifferentiated hypotension. Emergency Department (ED) point of care ultrasound (PoCUS) has been proposed as a potential non-invasive, rapid, repeatable investigation to ascertain inferior vena cava (IVC) characteristics. Our goal was to determine the feasibility of using PoCUS to measure IVC size and collapsibility. Methods: This was a planned secondary analysis of data from a prospective multicentre international study investigating PoCUS in ED patients with undifferentiated hypotension. We prospectively collected data on IVC size and collapsibility using a standard data collection form in 6 centres. The primary outcome was the proportion of patients with a clinically useful (determinate) scan defined as a clearly visible intrahepatic IVC, measurable for size and collapse. Descriptive statistics are provided. Results: A total of 138 scans were attempted on 138 patients; 45.7% were women and the median age was 58 years old. Overall, one hundred twenty-nine scans (93.5%; 95% CI 87.9 to 96.7%) were determinate. 131 (94.9%; 89.7 to 97.7%) were determinate for IVC size, and 131 (94.9%; 89.7 to 97.7%) were determinate for collapsibility. Conclusion: In this analysis of 138 ED patients with undifferentiated hypotension, the vast majority of PoCUS scans to investigate IVC characteristics were determinate. Future work should include analysis of the value of IVC size and collapsibility in determining fluid status in this group.

P1807COMPARISON BETWEEN INFERIOR VENA CAVA DIAMETER, BIOIMPEDANCE SPECTROSCOPY AND CLINICAL CRITERION FOR DRY WEIGHT ESTIMATION IN HEMODIALYZED CHILDREN

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Varvara Askiti ◽  
Georgia Malakasioti ◽  
George Servos ◽  
Georgia Grigoriadou ◽  
Andromachi Mitsioni
Keyword(s):  
Inferior Vena Cava ◽  
Inferior Vena ◽  
New Technologies ◽  
Fluid Overload ◽  
Vena Cava ◽  
Dry Weight ◽  
Chronic Hemodialysis ◽  
Hydration Status ◽  
Clinical Criteria

Abstract Background and Aims The determination of dry weight (DW) in children on chronic hemodialysis (HD) remains problematic. No method has been shown superior for DW assessment in the few pediatric studies exploring the utility of inferior vena cava expiratory and inspiratory diameter diameter (IVCDe, IVCDi) and BIS against clinical criteria. We aimed to compare the performance of IVCD, BIS and clinical judgement in DW prediction in hemodialyzed children. Method IVCD and BIS were measured serially pre and post the midweek HD session. IVCDi, IVCDe and IVC contractility index (IVCCI) associations with: (1) BIS estimated (BIS-relOH) and (2) clinically assessed hydration status (OHc) based on deviation from DW were explored. The interpretation of IVC measurements was based on previously published pediatric reference values. The level of agreement between the three tools in fluid overload recognition was studied. Results Fifty-two sets of measurements were undertaken in 13 patients (median age 11 years). OHc and BIS-relOH were positively associated to each other (r=0,5, p&lt;0,05) and to IVCDi (r=0,4, r=0,5, p&lt;0,05) and IVCDe (r=0,4, r=0,6, p&lt;0,05). A negative association between IVCCI and relOH-BIS was observed (r= -0,4, p&lt;0,05). There was a poor agreement between the three methods in identification of fluid overload; out of 28 clinically overloaded patients, BIS identified only 7 whereas IVCD none (Cohen’s k &lt;0). Conclusion IVCD measurements alone are not reliable for accurate fluid status prediction in hemodialyzed children as they seem to underestimate fluid overload compared to BIS and clinical criteria. Further studies are warranted to explore the applicability of new technologies for DW assessment of dialysis patients.

Single-access ultrasound-guided tunneled femoral lines in critically ill pediatric patients

2020 ◽  
Vol 21 (6) ◽  
pp. 1034-1041 ◽  
Author(s):  
Andrew Woerner ◽  
Jesse L Wenger ◽  
Eric J Monroe
Keyword(s):  
Critically Ill ◽  
Pediatric Patients ◽  
Point Of Care ◽  
Pediatric Population ◽  
Central Venous Access ◽  
Venous Access ◽  
Point Of Care Ultrasound ◽  
Ultrasound Guided ◽  
Patient Transport ◽  
Neonates And Infants

Central venous access is an essential aspect of critical care for pediatric patients. In the critically ill pediatric population, image-guided procedures performed at the bedside expedite care and may reduce risks and logistical challenges associated with patient transport to a remote procedure suite such as interventional radiology. We describe our institutional technique for ultrasound-guided tunneled femoral venous access in neonates and infants and provide technical pearls from our experience, with an intended audience including specialists performing point-of-care ultrasound–guided procedures as well as interventional radiologist making their services available in the intensive care unit.

scholarly journals Fluid Therapy in Pulmonary Disease: How Careful Do We Need to Be?

2021 ◽  
Vol 8 ◽  
Author(s):  
Sophie Adamantos
Keyword(s):  
Fluid Therapy ◽  
Fluid Overload ◽  
Point Of Care ◽  
Pulmonary Complications ◽  
Point Of Care Ultrasound ◽  
Protective Mechanisms ◽  
Non Invasive ◽  
Life Saving ◽  
Severe Hemorrhage ◽  
Healthy Dogs

Intravenous fluid therapy is a vital and life-saving therapeutic in veterinary medicine. In the absence of heart or lung disease, trauma or sepsis there is limited evidence that fluid therapy will have a detrimental effect on lung function. In healthy dogs there is a reasonable level of experimental evidence that supraphysiologic rates of fluid are required before signs of fluid overload are made evident. In cats, however, this may not be the case. There are higher rates of asymptomatic myocardial disease, but even in the absence of that it seems that some cats may be susceptible to fluid overload. Where systemic inflammation already exists the careful homeostatic and protective mechanisms within the lung are deranged and increases in hydrostatic pressure are more likely to result in fluid movement into the lung tissues. Strategies including restricting the use of intravenous crystalloid fluid administration and using blood products for management of severe hemorrhage are of increasing importance in human trauma and seem to be associated with fewer pulmonary complications, and lower mortality. Managing dogs and cats with sepsis and acute respiratory distress syndrome is already challenging, but ensuring adequate vascular expansion needs to be balanced with avoiding excessive volume administration which may negatively impact pulmonary function. While fluids remain crucial to management of these conditions, there will be an ongoing requirement to balance need without providing excess. The use of point of care ultrasound may provide clinicians with a non-invasive and accessible way to do this.

382 Portal Vein Pulsatility by Point-of-Care Ultrasound for Intravascular Fluid Status Assessment

2019 ◽  
Vol 74 (4) ◽  
pp. S149
Author(s):  
A. Gharib ◽  
T. The ◽  
F. Tohme ◽  
L. Jaeger ◽  
F. O'brien ◽  
...  
Keyword(s):  
Portal Vein ◽  
Point Of Care ◽  
Point Of Care Ultrasound ◽  
Fluid Status ◽  
Status Assessment

MO146RENAL FUNCTION MEDIATES THE EFFECT OF FLUID EXCESS ON LUNG CONGESTION IN PATIENTS WITH HFREF

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Raluca Popa ◽  
Radu Sascau ◽  
Cristian Statescu ◽  
Vlad Vasiliu ◽  
Andreea Neamtu ◽  
...  
Keyword(s):  
Renal Function ◽  
Direct Effect ◽  
Indirect Effects ◽  
Fluid Overload ◽  
Total Effect ◽  
Left Ventricular Ejection ◽  
Direct And Indirect Effects ◽  
Fluid Status ◽  
The Mean ◽  
B Lines

Abstract Background and Aims Despite impressive improvements in treatment strategies, heart failure (HF) morbidity and mortality remain substantially high worldwide. Pulmonary congestion is considered the leading cause for hospital admissions and death among patients with HF. The aim of this study is to investigate if the effect of fluid status, as assessed by bioimpedance spectroscopy (BIS) on lung congestion is mediated by renal function, inflammation or cardiac function. Method This was a prospective observational study of outpatient adults referred for clinically indicated transthoracic echocardiograms at an academic hospital between 2016 and 2018. A left ventricular ejection fraction (LVEF) below 45% was required for inclusion (HFrEF). Mediation is the process through which an exposure causes disease. We hypothesized that some of the total effect of extracellular water (ECW) to intracellular water (ICW) (as assessed by bioimpedance) ratio on lung congestion (as assessed by lung ultrasonography) is mediated by C-reactive protein (CRP), left atrium volum index (LAVI) or estimated glomerular filtration rate (eGFR) – the mediators. Results Our study included 153 patients. The mean age and eGFR values of the population at baseline were 67.1 years and 66.5 ml/min/1.73m2. The mean median value for CRP was 25.6 (IQR 9.0-56.4) mg/L. Figure 1 depicts the structural equation models with the calculated magnitude of the direct and indirect effects of ECW/ICW on the B-lines number in our population. In this model, the fluid status has both direct and indirect effects on lung congestion. Specifically, it has a direct effect on LAVI and eGFR, which in turn have a direct effect on the number of B-lines. Therefore, the indirect effect mediated by LAVI and eGFR accounts for a significant proportion of 27.6% of the total effect of ECW/ICW on lung congestion Although ECW/ICW has a direct effect on inflammation, this doesn’t have any effect on renal function or lung congestion. Conclusion We show that eGFR and LAVI partly mediate the effect of ECW/ICW on lung congestion in patients with HFrEF. While the deleterious effects of fluid overload on lung congestion have long been recognized, this study provides evidence for a relationship of significant magnitude linking fluid overload with decreased eGFR and increased LAVI, which in turn lead to elevations in the B-lines number. This work was supported by a grant of the Ministery of Research and Innovation, CNCS-UEFISCDI, project number PN-III-P1-1.1-PD-2016-0287, within PNCDI III and by a grant of the “Grigore T. Popa” University of Medicine and Pharmacy, contract number 27505/2018.

Optimizing Fluid Resuscitation and Preventing Fluid Overload in Patients with Septic Shock

2021 ◽  
Vol 42 (05) ◽  
pp. 698-705
Author(s):  
Chandni Ravi ◽  
Daniel W. Johnson
Keyword(s):  
Septic Shock ◽  
Fluid Overload ◽  
Point Of Care ◽  
Venous Pressure ◽  
Fluid Administration ◽  
Point Of Care Ultrasound ◽  
Shock State ◽  
Common Error ◽  
Intravenous Fluid Administration ◽  
Multiple Variables

AbstractIntravenous fluid administration remains an important component in the care of patients with septic shock. A common error in the treatment of septic shock is the use of excessive fluid in an effort to overcome both hypovolemia and vasoplegia. While fluids are necessary to help correct the intravascular depletion, vasopressors should be concomitantly administered to address vasoplegia. Excessive fluid administration is associated with worse outcomes in septic shock, so great care should be taken when deciding how much fluid to give these vulnerable patients. Simple or strict “recipes” which mandate an exact amount of fluid to administer, even when weight based, are not associated with better outcomes and therefore should be avoided. Determining the correct amount of fluid requires the clinician to repeatedly assess and consider multiple variables, including the fluid deficit, organ dysfunction, tolerance of additional fluid, and overall trajectory of the shock state. Dynamic indices, often involving the interaction between the cardiovascular and respiratory systems, appear to be superior to traditional static indices such as central venous pressure for assessing fluid responsiveness. Point-of-care ultrasound offers the bedside clinician a multitude of applications which are useful in determining fluid administration in septic shock. In summary, prevention of fluid overload in septic shock patients is extremely important, and requires the careful attention of the entire critical care team.

scholarly journals Man With Bilateral Leg Swelling

2019 ◽  
Vol 3 (4) ◽  
pp. 451-452
Author(s):  
Jake Toy ◽  
Alexander Garrett ◽  
Yiju Liu
Keyword(s):  
Emergency Department ◽  
Lower Extremity ◽  
Tumor Thrombus ◽  
Inferior Vena ◽  
Point Of Care ◽  
Vena Cava ◽  
Point Of Care Ultrasound ◽  
Heterogeneous Structure ◽  
Lower Extremity Edema ◽  
Primary Renal Cell Carcinoma

A 52-year-old man without known medical history presented with painful, progressive, bilateral lower extremity edema over a two-week period. An abdominal exam noted a firm left upper quadrant mass. Emergency department (ED) point-of-care ultrasound (POCUS) revealed a hyperechoic, heterogeneous structure in the inferior vena cava that was determined to represent a tumor thrombus extending from a primary renal cell carcinoma. This case demonstrates how POCUS was valuable in rapidly diagnosing this rare cause of lower extremity edema and its usefulness in directing the initial ED management of this patient.

390: TRAINING NURSES TO ASSESS FLUID STATUS USING POINT-OF-CARE ULTRASOUND

2018 ◽  
Vol 46 (1) ◽  
pp. 178-178 ◽  
Author(s):  
Sara Crager ◽  
Chris Cinkowski ◽  
Laleh Gharahbaghian
Keyword(s):  
Point Of Care ◽  
Point Of Care Ultrasound ◽  
Fluid Status

scholarly journals Dynamic Changes in Portal Vein Flow during Decongestion in Patients with Heart Failure and Cardio-Renal Syndrome: A POCUS Case Series

2021 ◽  
pp. 1-8
Author(s):  
Eduardo R. Argaiz ◽  
Philippe Rola ◽  
Gerardo Gamba
Keyword(s):  
Heart Failure ◽  
Portal Vein ◽  
Point Of Care ◽  
Vena Cava ◽  
Case Series ◽  
Kidney Injury ◽  
Venous Congestion ◽  
Point Of Care Ultrasound ◽  
Optimal Method ◽  
Portal Vein Flow

<b><i>Introduction:</i></b> Optimal method for noninvasive assessment of venous congestion remains an unresolved issue. Portal vein (PV) and intrarenal venous flow alterations are markers of abdominal venous congestion and have been associated with acute kidney injury (AKI) in cardiac surgery patients. It is currently unknown if portal vein flow (PVF) alterations in heart failure can be reversed with diuretic treatment and track decongestion. <b><i>Objective:</i></b> The aim of this study is to evaluate PVF alterations in patients with ADHF at arrival and after decongestive treatment. <b><i>Methods:</i></b> Assessment of venous congestion using point-of-care ultrasound was performed in 12 patients with ADHF (6 patients with left-sided heart failure and 6 patients with right-sided heart failure). Evaluation included inferior vena cava (IVC) size and collapsibility in addition to PV Doppler to determine pulsatility fraction (PF). <b><i>Results:</i></b> Increased PV PF (81.75 ± 13%) was found on admission. After effective decongestive treatment, it improved to (17.43 ± 2.2%). Improvement in IVC size and collapsibility was seen in most patients with left-sided heart failure and none of the patients with right-sided heart failure. Improvement in PV PF coincided with return to baseline of Serum Cr in patients that presented with AKI. <b><i>Conclusions:</i></b> Evaluation of abdominal venous congestion by point-of-care ultrasound could aid in diagnosis and follow-up of patients with congestive kidney injury.

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