Predicting and measuring fluid responsiveness with echocardiography
Ashley Miller, Justin Mandeville, Ashley Miller, Justin Mandeville
Abstract
Echocardiography is ideally suited to guide fluid resuscitation in critically ill patients. It can be used to assess fluid responsiveness by looking at the left ventricle, aortic outflow, inferior vena cava and right ventricle. Static measurements and dynamic variables based on heart-lung interactions all combine to predict and measure fluid responsiveness and assess response to intravenous fluid resuscitation. Thorough knowledge of these variables, the physiology behind them and the pitfalls in their use allows the echocardiographer to confidently assess these patients and in combination with clinical judgement manage them appropriately.
Keywords: echocardiography; guidelines; haemodynamics; ultrasound protocols; ventricular function.
© 2016 The authors.
Figures
References
- Wiedemann HP, Wheeler AP, Bernard GR, Thompson BT, Hayden D, deBoisblanc B, Connors AF, Jr, Hite RD, Harabin AL. 2006. Comparison of two fluid-management strategies in acute lung injury. New England Journal of Medicine 354 2564–2575. 10.1056/NEJMoa062200
- Boyd JH, Forbes J, Nakada T, Walley KR, Russell JA. 2011. Fluid resuscitation in septic shock: a positive fluid balance and elevated central venous pressure are associated with increased mortality. Critical Care Medicine 39 259–265. 10.1097/CCM.0b013e3181feeb15
- Michard F. 2002. Predicting fluid responsiveness in ICU patients: a critical analysis of the evidence. Chest 121 2000–2008. 10.1378/chest.121.6.2000
- Marik PE, Cavallazzi R, Vasu T, Hirani A. 2009. Dynamic changes in arterial waveform derived variables and fluid responsiveness in mechanically ventilated patients: a systematic review of the literature. Critical Care Medicine 37 2642–2647. 10.1097/CCM.0b013e3181a590da
- Magder S, De Varennes B. 1998. Clinical death and the measurement of stressed vascular volume. Critical Care Medicine 26 1061–1064. 10.1097/00003246-199806000-00028
- Gelman S. 2008. Venous function and central venous pressure: a physiologic story. Anesthesiology 108 735–748. 10.1097/ALN.0b013e3181672607
- Marik PE, Baram M, Vahid B. 2008. Does central venous pressure predict fluid responsiveness? A systematic review of the literature and the tale of seven mares. Chest 134 172–178. 10.1378/chest.07-2331
- Perel A, Pizov R, Cotev S. 1987. Systolic blood pressure variation is a sensitive indicator of hypovolemia in ventilated dogs subjected to graded hemorrhage. Anesthesiology 67 498–502. 10.1097/00000542-198710000-00009
- Chew MS. 2012. Haemodynamic monitoring using echocardiography in the critically ill: a review. Cardiology Research and Practice 2012 139537 10.1155/2012/139537
- Tavernier B, Makhotine O, Lebuffe G, Dupont J, Scherpereel P. 1998. Systolic pressure variation as a guide to fluid therapy in patients with sepsis-induced hypotension. Anesthesiology 89 1313–1321. 10.1097/00000542-199812000-00007
- Mandeville JC, Colebourn CL. 2013. Predicting fluid responsiveness in the critically ill adult. British Journal of Intensive Care 23 20–26. 10.1155/2012/513480
- Feissel M, Michard F, Mangin I, Ruyer O, Faller JP, Teboul JL. 2001. Respiratory changes in aortic blood velocity as an indicator of fluid responsiveness in ventilated patients with septic shock. Chest 119 867–873. 10.1378/chest.119.3.867
- Tousignant CP, Walsh F, Mazer CD. 2000. The use of transesophageal echocardiography for preload assessment in critically ill patients. Anesthesia & Analgesia 90 351–355. 10.1213/00000539-200002000-00021
- Cannesson M, Slieker J, Desebbe O, Farhat F, Bastien O, Lehot J-J. 2006. Prediction of fluid responsiveness using respiratory variations in left ventricular stroke area by transoesophageal echocardiographic automated border detection in mechanically ventilated patients. Critical Care 10 R171 10.1186/cc5123
- Chauvet J-L, El-Dash S, Delastre O, Bouffandeau B, Jusserand D, Michot J-B, Bauer F, Maizel J, Slama M. 2015. Early dynamic left intraventricular obstruction is associated with hypovolemia and high mortality in septic shock patients. Critical Care 19 262. 10.1186/s13054-015-0980-z
- Muller L, Louart G, Bousquet P-J, Candela D, Zoric L, Coussaye J-E, Jaber S, Lefrant J-Y. 2009. The influence of the airway driving pressure on pulsed pressure variation as a predictor of fluid responsiveness. Intensive Care Medicine 36 496–503. 10.1007/s00134-009-1686-y
- Tavernier B, Robin E. 2011. Assessment of fluid responsiveness during increased intra-abdominal pressure: keep the indices, but change the thresholds. Critical Care 15 134 10.1186/cc10074
- de Waal EEC, Rex S, Kruitwagen CLJJ, Kalkman CJ, Buhre WF. 2009. Dynamic preload indicators fail to predict fluid responsiveness in open-chest conditions. Critical Care Medicine 7 510–515. 10.1097/CCM.0b013e3181958bf7
- Mahjoub Y, Lejeune V, Muller L, Perbet S, Zieleskiewicz L, Bart F, Veber B, Paugam-Burtz C, Jaber S, Ayham A, et al. 2014. Evaluation of pulse pressure variation validity criteria in critically ill patients: a prospective observational multicentre point-prevalence study. British Journal of Anaesthesia 112 681–685. 10.1093/bja/aet442
- Jardin F, Vieillard-Baron A. 2006. Ultrasonographic examination of the venae cavae. Intensive Care Medicine 32 203–206. 10.1007/s00134-005-0013-5
- Jue J, Chung W, Schiller NB. 1992. Does inferior vena cava size predict right atrial pressures in patients receiving mechanical ventilation? Journal of the American Society of Echocardiography 5 613–619. 10.1016/S0894-7317(14)80327-1
- Brennan JM, Blair JE, Goonewardena S, Ronan A, Shah D, Vasaiwala S, Kirkpatrick JN, Spencer KT. 2007. Reappraisal of the use of inferior vena cava for estimating right atrial pressure. Journal of the American Society of Echocardiography 20 857–861. 10.1016/j.echo.2007.01.005
- Feissel M, Michard F, Faller J-P, Teboul J-L. 2004. The respiratory variation in inferior vena cava diameter as a guide to fluid therapy. Intensive Care Medicine 30 1834–1837.
- Barbier C, Loubières Y, Schmit C, Hayon J, Ricôme J-L, Jardin F, Vieillard-Baron A. 2004. Respiratory changes in inferior vena cava diameter are helpful in predicting fluid responsiveness in ventilated septic patients. Intensive Care Medicine 30 1740–1746.
- Airapetian N, Maizel J, Alyamani O, Mahjoub Y, Lorne E, Levrard M, Ammenouche N, Seydi A, Tinturier F, Lobjoie E, et al. 2015. Does inferior vena cava respiratory variability predict fluid responsiveness in spontaneously breathing patients? Critical Care 19 400. 10.1186/s13054-015-1100-9
- Vieillard-Baron A, Chergui K, Rabiller A, Peyrouset O, Page B, Beauchet A, Jardin F. 2004. Superior vena caval collapsibility as a gauge of volume status in ventilated septic patients. Intensive Care Medicine 30 1734–1739.
- Mercat A, Diehl JL, Meyer G, Teboul JL, Sors H. 1999. Hemodynamic effects of fluid loading in acute massive pulmonary embolism. Critical Care Medicine 27 540–544. 10.1097/00003246-199903000-00032
- Cavallaro F, Sandroni C, Marano C, La Torre G, Mannocci A, De Waure C, Bello G, Maviglia R, Antonelli M. 2010. Diagnostic accuracy of passive leg raising for prediction of fluid responsiveness in adults: systematic review and meta-analysis of clinical studies. Intensive Care Medicine 36 1475–1483. 10.1007/s00134-010-1929-y
- Vincent J-L, Weil MH. 2006. Fluid challenge revisited. Critical Care Medicine 34 1333–1337. 10.1097/01.CCM.0000214677.76535.A5
- Muller L, Toumi M, Bousquet P-J, Riu-Poulenc B, Louart G, Candela D, Zoric L, Suehs C, de La Coussaye JE, Molinari N, et al. 2011. An increase in aortic blood flow after an infusion of 100 ml colloid over 1 minute can predict fluid responsiveness: the mini-fluid challenge study. Anesthesiology 115 541–547. 10.1097/ALN.0b013e318229a500
- Hilton AK, Bellomo R. 2012. A critique of fluid bolus resuscitation in severe sepsis. Critical Care 16 302 10.1186/cc11154
Source: PubMed