Showing posts with label fluid responsiveness. Show all posts
Showing posts with label fluid responsiveness. Show all posts

Sunday, November 3, 2019

Inferior Vena Cava Assessments with US

Ultrasound assessment of the inferior vena cava for fluid responsiveness: easy, fun, but unlikely to be helpful

This is where I stand on the matter today, November 3rd, 2020. I am open to changing my mind with new data. Guiding fluid responsiveness, as I’ve covered here, is a huge pain in the butt. But giving patients either too little fluids or too much fluids increases mortality. That little feeling inside of “just doing something” isn’t the best thing.

When I was going to through fellowship, I was trained to perform this assessment of placing the US probe on the patients subxiphoid area and digging around until the IVC was found. I got pretty good at it, but I have to admit that I also haven’t used it in 2 years. I never found it to be as useful or reliable as I initially thought it would be. It’s a tool but it has many caveats. I remember reading this article and got some confirmation bias to how I already felt about the scan.

Fortunately, this article is free and you can download it on my website, eddyjoemd.com. The article illustrates the many caveats which any clinician developing the skill to perform this scan NEEDS to know. He discusses the technical limitations, confounding factors, and reviews the evidence in both patients who are spontaneously breathing and in those who are on the vent.

I’ll repeat again, if you are a medical student, emergency medicine resident, internal medicine resident, or any clinician learning and managing patients based on this scan, you need to know the limitations of it. At least until we find the holy grail of Critical Care where we find a way to know the correct amount of fluids to give our patients. Not a drop more or a drop less.



Link to Abstract

Link to FREE FULL PDF

Millington, S.J. Can J Anesth/J Can Anesth (2019) 66: 633. https://doi.org/10.1007/s12630-019-01357-0

Saturday, November 2, 2019

Incorporating Dynamic Assessment of Fluid Responsiveness Into Goal-Directed Therapy: A Systematic Review and Meta-Analysis.

Incorporating Dynamic Assessment of Fluid Responsiveness Into Goal-Directed Therapy: A Systematic Review and Meta-Analysis.

Let’s talk a little bit about resuscitation. I chose to go down this path to start off the weekend bc I frequently see patients receiving arbitrary fluid boluses for SBP less than x (we all know how o feel about using systolics on oscillometric machines), MAP less than 65, or decreased urine output. It makes us feel like we are doing something but we are actually causing harm. At the end of the day, giving fluid just to make the blood pressure pretty does not indicate fluid responsiveness. If I were to give you a liter of fluid, definitely not saline, your BP would go up. That doesn’t mean you’re fluid responsive. Using the technologies listed in this article from 2017 are a step in the right direction. If you read the validation studies for them you’ll learn that they leave much to be desired but they’re amongst the best tools we have today. I’m going to go much deeper down this rabbit hole in the upcoming months.

What do you use at your shop to measure fluid responsiveness?

Link to Abstract

Link to FULL FREE PDF

Bednarczyk JM, Fridfinnson JA, Kumar A, et al. Incorporating Dynamic Assessment of Fluid Responsiveness Into Goal-Directed Therapy: A Systematic Review and Meta-Analysis. Crit Care Med. 2017;45(9):1538–1545. doi:10.1097/CCM.0000000000002554

Although great care has been taken to ensure that the information in this post is accurate, eddyjoemd, LLC shall not be held responsible or in any way liable for the continued accuracy of the information, or for any errors, omissions or inaccuracies, or for any consequences arising therefrom.