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.

scholarly journals Non-Invasive Intracranial Pressure Evaluation in an Emergency Room – Point-of-Care Ultrasonography

2016 ◽  
Vol 38 (04) ◽  
pp. 279-283
Author(s):  
Daniel Damiani ◽  
Durval Damiani
Keyword(s):  
Intracranial Pressure ◽  
Randomized Trials ◽  
Point Of Care ◽  
Current Data ◽  
Point Of Care Ultrasound ◽  
Medical Specialties ◽  
Non Invasive ◽  
Nerve Sheath ◽  
Invasive Method ◽  
Point Of Care Ultrasonography

AbstractPoint-of-care ultrasound is modifying conducts in emergency care. The various medical specialties, in addition to traditional indications in cases of multiple trauma, are using this technique for rapid diagnosis at the bedside without patient mobilization and without radiation. Point-of-care ultrasound in neurocritical patients, through its transorbital window, can estimate the intracranial pressure by a non-invasive method. Through the measurement of the diameter of the optic nerve sheath 3 mm posterior to the retina, the intracranial pressure is estimated if the value of the diameter is > 5 mm, as it has been verified in other studies. The present article describes the most current data on this topic, and it also highlights the need for more multicentric and randomized trials to determine the correct cut-off points that represent the high sensibility and specificity of the method.

scholarly journals A History of Fluid Management—From “One Size Fits All” to an Individualized Fluid Therapy in Burn Resuscitation

Medicina ◽  
2021 ◽  
Vol 57 (2) ◽  
pp. 187
Author(s):  
Dorothee Boehm ◽  
Henrik Menke
Keyword(s):  
Fluid Therapy ◽  
Point Of Care ◽  
Fluid Management ◽  
Point Of Care Ultrasound ◽  
Burn Patients ◽  
Starting Point ◽  
History Of ◽  
Definition Of ◽  
Historical Developments ◽  
Burn Resuscitation

Fluid management is a cornerstone in the treatment of burns and, thus, many different formulas were tested for their ability to match the fluid requirements for an adequate resuscitation. Thereof, the Parkland-Baxter formula, first introduced in 1968, is still widely used since then. Though using nearly the same formula to start off, the definition of normovolemia and how to determine the volume status of burn patients has changed dramatically over years. In first instance, the invention of the transpulmonary thermodilution (TTD) enabled an early goal directed fluid therapy with acceptable invasiveness. Furthermore, the introduction of point of care ultrasound (POCUS) has triggered more individualized schemes of fluid therapy. This article explores the historical developments in the field of burn resuscitation, presenting different options to determine the fluid requirements without missing the red flags for hyper- or hypovolemia. Furthermore, the increasing rate of co-morbidities in burn patients calls for a more sophisticated fluid management adjusting the fluid therapy to the actual necessities very closely. Therefore, formulas might be used as a starting point, but further fluid therapy should be adjusted to the actual need of every single patient. Taking the developments in the field of individualized therapies in intensive care in general into account, fluid management in burn resuscitation will also be individualized in the near future.

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 Diagnosing Early Cardiac Tamponade in Patient with JAK2+ Myeloproliferative Syndrome with Point of Care Ultrasound

POCUS Journal ◽  
2021 ◽  
Vol 6 (1) ◽  
pp. 13-15
Author(s):  
Evan Cameron ◽  
Lawrence Istrail
Keyword(s):  
User Interface ◽  
Cardiac Tamponade ◽  
Point Of Care ◽  
Handheld Devices ◽  
Point Of Care Ultrasound ◽  
Diagnostic Modality ◽  
Non Invasive ◽  
Myeloproliferative Syndrome ◽  
Life Threatening ◽  
New Diagnosis

Point of care ultrasound (POCUS) is a diagnostic modality growing in popularity and use in medicine in both the acute and chronic management settings. Its utility lies in its non-invasive application, direct user interface, and portability, especially in handheld devices, allowing for quick assessment and triage. Herein is a case of POCUS diagnosing life threatening cardiac tamponade in a patient with a new diagnosis of JAK2+ myeloproliferative syndrome prompting urgent intervention with pericardiocentesis. This case illustrates the utility of POCUS through its ability to serve as a quick diagnostic tool that can hasten intervention for potentially life-threatening conditions.   

scholarly journals Point of Care Ultrasound to Identify Diaphragmatic Dysfunction after Thoracic Surgery

2019 ◽  
Vol 131 (2) ◽  
pp. 266-278 ◽  
Author(s):  
S. Spadaro ◽  
S. Grasso ◽  
M. Dres ◽  
A. Fogagnolo ◽  
F. Dalla Corte ◽  
...  
Keyword(s):  
Odds Ratio ◽  
Thoracoscopic Surgery ◽  
Point Of Care ◽  
Pulmonary Complications ◽  
Point Of Care Ultrasound ◽  
Postoperative Pulmonary Complications ◽  
Diaphragmatic Dysfunction ◽  
Video Assisted ◽  
Diaphragmatic Function ◽  
Video Assisted Thoracoscopic Surgery

Abstract Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New Background Postoperative diaphragmatic dysfunction after thoracic surgery is underestimated due to the lack of reproducible bedside diagnostic methods. We used point of care ultrasound to assess diaphragmatic function bedside in patients undergoing video-assisted thoracoscopic or thoracotomic lung resection. Our main hypothesis was that the thoracoscopic approach may be associated with lower incidence of postoperative diaphragm dysfunction as compared to thoracotomy. Furthermore, we assessed the association between postoperative diaphragmatic dysfunction and postoperative pulmonary complications. Methods This was a prospective observational cohort study. Two cohorts of patients were evaluated: those undergoing video-assisted thoracoscopic surgery versus those undergoing thoracotomy. Diaphragmatic dysfunction was defined as a diaphragmatic excursion less than 10 mm. The ultrasound evaluations were carried out before (preoperative) and after (i.e., 2 h and 24 h postoperatively) surgery. The occurrence of postoperative pulmonary complications was assessed up to 7 days after surgery. Results Among the 75 patients enrolled, the incidence of postoperative diaphragmatic dysfunction at 24 h was higher in the thoracotomy group as compared to video-assisted thoracoscopic surgery group (29 of 35, 83% vs. 22 of 40, 55%, respectively; odds ratio = 3.95 [95% CI, 1.5 to 10.3]; P = 0.005). Patients with diaphragmatic dysfunction on the first day after surgery had higher percentage of postoperative pulmonary complications (odds ratio = 5.5 [95% CI, 1.9 to 16.3]; P = 0.001). Radiologically assessed atelectasis was 46% (16 of 35) in the thoracotomy group versus 13% (5 of 40) in the video-assisted thoracoscopic surgery group (P = 0.040). Univariate logistic regression analysis indicated postoperative diaphragmatic dysfunction as a risk factor for postoperative pulmonary complications (odds ratio = 5.5 [95% CI, 1.9 to 16.3]; P = 0.002). Conclusions Point of care ultrasound can be used to evaluate postoperative diaphragmatic function. On the first postoperative day, diaphragmatic dysfunction was less common after video-assisted than after the thoracotomic surgery and is associated with postoperative pulmonary complications.

Point of care ultrasound versus CT pulmonary angiogram in suspected pulmonary embolus

2017 ◽  
Vol 34 (7) ◽  
pp. 487.2-489
Author(s):  
Joseph Bacani Bacani ◽  
Kerstin De Wit
Keyword(s):  
Pulmonary Embolus ◽  
Point Of Care ◽  
Clinical Suspicion ◽  
Point Of Care Ultrasound ◽  
Clinical Question ◽  
Non Invasive ◽  
Pulmonary Angiogram ◽  
Definitive Statement ◽  
Ct Pulmonary Angiogram ◽  
Study Type

A short cut review was carried out to establish whether non-invasive, multi-organ point of care ultrasound could reduce the need for CTPA in adult patients presenting with clinical suspicion of pulmonary embolus. 3 papers presented the best evidence to answer the clinical question. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of these papers are tabulated. It is concluded that multi-organ POCUS shows promise but that more data is needed to make a definitive statement regarding validity in clinical practice.

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 P056: Non-invasive measurement of the central venous pressure using near-infrared spectroscopy versus point-of-care ultrasound

CJEM ◽  
2018 ◽  
Vol 20 (S1) ◽  
pp. S76-S77
Author(s):  
N. Goumeniouk ◽  
J. Newbigging ◽  
M. McDonnell ◽  
M.L.A. Sivilotti
Keyword(s):  
Emergency Department ◽  
Infrared Spectroscopy ◽  
Near Infrared ◽  
Point Of Care ◽  
Venous Pressure ◽  
Point Of Care Ultrasound ◽  
Central Venous ◽  
Non Invasive ◽  
Secondary Outcomes ◽  
Invasive Measurement

Introduction: A fundamental hemodynamic parameter, the central venous pressure (CVP) is rarely available in the emergency patient due the delay and risks inherent to central vein cannulation. Recently, two non-invasive strategies have emerged: a) point-of-care ultrasound to supplement traditional inspection the internal jugular waveform ; or b) near-infrared spectroscopy (NIRS) of the external jugular vein. Methods: Five medical students underwent standardized training on both NIRS device (Venus 2000 CVP; Mespere Life Sciences, Waterloo ON) and ultrasound-assisted CVP assessment. During prescheduled, randomly permuted and balanced shifts, a pair of students obtained blinded independent measurements using each device within 10 minutes of each other. High priority subjects likely to have abnormal CVP (e.g. vomiting, dehydrated, heart failure, sepsis) were approached preferentially, followed by a convenience sample of other eligible patients in the emergency department. Secondary outcomes were stopwatch-recorded time from device ready to stable measurement, as well as operator ease, operator confidence and patient discomfort. The blinded treating physician rated each subjects volume status on an ordered scale: depleted, neutral and overloaded. Results: We enrolled 104 patients (median [IQR] age 68 [53, 78] years; 50% male; BMI 27.6 [17.0, 47.7] kg/m2; admission rate 27%) in June-August 2017. Treating physicians classified 17 as volume depleted and 12 overloaded. CVP measurements differed widely between techniques: ultrasound 8 [7, 9] cmH2O (3 cases unobtainable) vs NIRS 12 [8, 17] cmH2O (13 unobtainable). Agreement and correlation between the two devices was extremely low (R2=0.04). While neither technique demonstrated a strong association with the treating physicians estimate of volume status, only the ultrasound values increased monotonically with physician estimate. With regards to secondary outcomes, ultrasound measurements took less time (paired difference 50 seconds [95% CI 7, 93]), and operators were more confident (0.63 [0.02, 1.23] out of 10) and at ease (0.78, [0.13, 1.43]) with ultrasound; patients rated discomfort equally (-0.06 [-0.30, 0.18]). Conclusion: Non-invasive measurement of CVP remains a challenge in the emergency department. The external jugular pressure by NIRS has very high variability and poor agreement with ultrasound-enhanced inspection of the internal jugular, suggesting that this technique is not yet practical for use by non-experts.

scholarly journals Validation of Point-of-Care Ultrasound to Measure Perioperative Edema in Infants With Congenital Heart Disease

2021 ◽  
Vol 9 ◽  
Author(s):  
Jessica N. Persson ◽  
Jacqueline Holstein ◽  
Lori Silveira ◽  
Aimee Irons ◽  
Taufiek Konrad Rajab ◽  
...  
Keyword(s):  
Congenital Heart Disease ◽  
Cardiac Surgery ◽  
Heart Disease ◽  
Congenital Heart ◽  
Fluid Overload ◽  
Subcutaneous Tissue ◽  
Point Of Care ◽  
Point Of Care Ultrasound ◽  
Extravascular Fluid ◽  
Skin Ultrasound

Purpose: Fluid overload is a common post-operative issue in children following cardiac surgery and is associated with increased morbidity and mortality. There is currently no gold standard for evaluating fluid status. We sought to validate the use of point-of-care ultrasound to measure skin edema in infants and assess the intra- and inter-user variability.Methods: Prospective cohort study of neonates (≤30 d/o) and infants (31 d/o to 12 m/o) undergoing cardiac surgery and neonatal controls. Skin ultrasound was performed on four body sites at baseline and daily post-operatively through post-operative day (POD) 3. Subcutaneous tissue depth was manually measured. Intra- and inter-user variability was assessed using intraclass correlation coefficient (ICC).Results: Fifty control and 22 surgical subjects underwent skin ultrasound. There was no difference between baseline surgical and control neonates. Subcutaneous tissue increased in neonates starting POD 1 with minimal improvement by POD 3. In infants, this pattern was less pronounced with near resolution by POD 3. Intra-user variability was excellent (ICC 0.95). Inter-user variability was very good (ICC 0.82).Conclusion: Point-of-care skin ultrasound is a reproducible and reliable method to measure subcutaneous tissue in infants with and without congenital heart disease. Acute increases in subcutaneous tissue suggests development of skin edema, consistent with extravascular fluid overload. There is evidence of skin edema starting POD 1 in all subjects with no substantial improvement by POD 3 in neonates. Point-of-care ultrasound could be an objective way to measure extravascular fluid overload in infants. Further research is needed to determine how extravascular fluid overload correlates to clinical outcomes.

Point-of-care ultrasound (POCUS) as the keystone investigation in undifferentiated dyspnoea

2020 ◽  
Vol 13 (6) ◽  
pp. e234602
Author(s):  
Sara Montemerani ◽  
Valeria Donati ◽  
Nicola Di Pietra ◽  
Giovanni Iannelli
Keyword(s):  
Respiratory Failure ◽  
Point Of Care ◽  
High Rate ◽  
Chronic Obstructive ◽  
Subjective Perception ◽  
Point Of Care Ultrasound ◽  
Obstructive Pulmonary Disease ◽  
Require Time ◽  
Non Invasive ◽  
Common Causes

Dyspnoea is defined as a subjective perception of laboured breathing. It is a common cause of access to the emergency department (ED), it has a high rate of intensive care unit admission and a high mortality. The most common causes of dyspnoea in the adult include pneumonia, heart failure, chronic obstructive pulmonary disease, pulmonary embolism and asthma. Due to the high variety of dyspnoea’s causes, the need for a rapid and accurate diagnosis puts the emergency physician in trouble. Moreover, standard tests such as chest radiography, B-type natriuretic peptide and d-dimer require time and may be less useful in patients with respiratory failure who require urgent therapy. Point-of-care ultrasound (POCUS) is rapid, non-invasive, repeatable and a useful tool in evaluating patients with acute and severe dyspnoea. This case report demonstrates the usefulness of POCUS in a patient with undifferentiated respiratory failure presenting to the ED.

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