3/13/2023 0 Comments Imail org emailAs excess fluid administration can be harmful, it was deemed unethical to actually administer fluid in every patient. In one mixed ICU that where such sedation is rare, those ultrasound measurements were feasible in around 1% of patients receiving fluid challenges ( 6).Īnother aspect of Vignon’s study worth considering is the use of a passive leg raise as a surrogate for successful volume expansion. ![]() While the study intensive care unit had a large proportion of patients passively ventilated, these patients may be less common in several contemporary medical intensive care units (ICUs). Despite the reported high feasibility, these measurements still are limited only to patients receiving mechanical ventilation who are either receiving neuromuscular blockade or are sedated so heavily as to not generate any spontaneous breathing effort. The high diagnostic accuracy and high feasibility of these techniques suggest that it is reasonable to apply them in the critical care setting. Vignon and colleagues have presciently assessed the feasibility of these measurements for patients in a mixed intensive care unit before these assessments have been fully adopted by the average intensivist. A key reason for the decreased effect size in subsequent larger studies is decreased external validity and decreased generalizability ( 5). It is only much later that larger studies will negate or demonstrate reduced effect size of initial study. Typically, enthusiasm for these novel techniques is based on the initial studies, and feasibility is rarely assessed until after widespread adoption. The initial studies that demonstrated diagnostic accuracy of aortic velocity variation, or vena cava diameter variation were small, usually less than 50 patients, and were studied only under specific physiologic states, such as sepsis, or passive mechanical ventilation ( 2- 4). Several patients are excluded in order to increase the internal validity. Typically, initial studies are small in size, and ignore feasibility. It also appeared that superior vena cava collapsibility was the most predictive of the echocardiographic measures.įeasibility is a challenging aspect when studying novel therapies or diagnostic techniques. The inferior vena cava, pulse pressure variation, and aortic velocity could not be measured in 22% of patients due to image acquisition or absence of sinus rhythm, while superior vena cava could be measured in nearly all patients. Also commendable is their reporting of feasibility. Their study is commendable for its large size, and its inclusion of several different categories of acute circulatory failure, including sepsis, hypovolemia, and cardiogenic shock. Vignon and colleagues recently compared multiple echocardiographic indices to predict fluid responsiveness in ventilated patients ( 1). Several small studies have demonstrated the utility of echocardiographic measures that exploit heart-lung interactions to predict fluid responsiveness in selected patients. Over the past decade, it has become apparent that the conventional methods of assessing fluid responsiveness with static measures, like central venous pressure, are inaccurate. Inappropriate administration of fluid, however, results in increased mortality and morbidity. ![]() Despite several scientific advances, administration of intravenous crystalloid remains a key therapy. Shock remains a common and lethal syndrome. Comparison of Echocardiographic Indices Used to Predict Fluid Responsiveness in Ventilated Patients. ![]() ![]() Email: This is an invited Editorial commissioned by the Section Editor Zhiheng Xu (State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Disease, Department of Intensive Care, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China).Ĭomment on: Vignon P, Repessé X, Bégot E, et al. Critical Care Echocardiography Service, Intermountain Medical Center and University of Utah, Salt Lake City, UT 84107, USA.
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