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Perioperative intravascular fluid assessment and monitoring: a narrative review of established and emerging techniques.

Singh S, Kuschner WG, Lighthall G - Anesthesiol Res Pract (2011)

Bottom Line: Accurate assessments of intravascular fluid status are an essential part of perioperative care and necessary in the management of the hemodynamically unstable patient.Goal-directed fluid management can facilitate resuscitation of the hypovolemic patient, reduce the risk of fluid overload, reduce the risk of the injudicious use of vasopressors and inotropes, and improve clinical outcomes.In this paper, we discuss the strengths and limitations of a spectrum of noninvasive and invasive techniques for assessing and monitoring intravascular volume status and fluid responsiveness in the perioperative and critically ill patient.

View Article: PubMed Central - PubMed

Affiliation: Department of Anesthesiology and Critical Care, Ronald Reagan UCLA Medical Center, David Geffen School of Medicine at UCLA, 757 Westwood Plaza, Suite 2231, Los Angeles, CA, 90095, USA.

ABSTRACT
Accurate assessments of intravascular fluid status are an essential part of perioperative care and necessary in the management of the hemodynamically unstable patient. Goal-directed fluid management can facilitate resuscitation of the hypovolemic patient, reduce the risk of fluid overload, reduce the risk of the injudicious use of vasopressors and inotropes, and improve clinical outcomes. In this paper, we discuss the strengths and limitations of a spectrum of noninvasive and invasive techniques for assessing and monitoring intravascular volume status and fluid responsiveness in the perioperative and critically ill patient.

No MeSH data available.


Related in: MedlinePlus

A subcostal view of the cavoatrial junction and adjacent structures. RA: right atrium; IVC: inferior vena cava; LIV: liver.
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fig3: A subcostal view of the cavoatrial junction and adjacent structures. RA: right atrium; IVC: inferior vena cava; LIV: liver.

Mentions: Improved image quality with portable study echo machines in the last decade has made TTE a popular tool for intravascular fluid assessment in the ICU. More recently, its use has been advocated in the perioperative settings due to its ability to provide quick, noninvasive functional and fluid assessment. Right heart preload can be reliably obtained by direct measurement of the inferior vena cava diameter (IVC) variations with respiration (Figure 3) and also by right and left ventricular end-diastolic volumes. One study showed that a 50% decrease in IVC diameter (caval index), seen by subcostal views with spontaneous breathing, correlated with an RA pressure of less than 10 mm Hg (mean SD 6 ± 5), as measured by CVP measurements [71]. Recent study in emergency department settings found caval index measurement a useful noninvasive tool for initial determination of CVP [72].


Perioperative intravascular fluid assessment and monitoring: a narrative review of established and emerging techniques.

Singh S, Kuschner WG, Lighthall G - Anesthesiol Res Pract (2011)

A subcostal view of the cavoatrial junction and adjacent structures. RA: right atrium; IVC: inferior vena cava; LIV: liver.
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3139886&req=5

fig3: A subcostal view of the cavoatrial junction and adjacent structures. RA: right atrium; IVC: inferior vena cava; LIV: liver.
Mentions: Improved image quality with portable study echo machines in the last decade has made TTE a popular tool for intravascular fluid assessment in the ICU. More recently, its use has been advocated in the perioperative settings due to its ability to provide quick, noninvasive functional and fluid assessment. Right heart preload can be reliably obtained by direct measurement of the inferior vena cava diameter (IVC) variations with respiration (Figure 3) and also by right and left ventricular end-diastolic volumes. One study showed that a 50% decrease in IVC diameter (caval index), seen by subcostal views with spontaneous breathing, correlated with an RA pressure of less than 10 mm Hg (mean SD 6 ± 5), as measured by CVP measurements [71]. Recent study in emergency department settings found caval index measurement a useful noninvasive tool for initial determination of CVP [72].

Bottom Line: Accurate assessments of intravascular fluid status are an essential part of perioperative care and necessary in the management of the hemodynamically unstable patient.Goal-directed fluid management can facilitate resuscitation of the hypovolemic patient, reduce the risk of fluid overload, reduce the risk of the injudicious use of vasopressors and inotropes, and improve clinical outcomes.In this paper, we discuss the strengths and limitations of a spectrum of noninvasive and invasive techniques for assessing and monitoring intravascular volume status and fluid responsiveness in the perioperative and critically ill patient.

View Article: PubMed Central - PubMed

Affiliation: Department of Anesthesiology and Critical Care, Ronald Reagan UCLA Medical Center, David Geffen School of Medicine at UCLA, 757 Westwood Plaza, Suite 2231, Los Angeles, CA, 90095, USA.

ABSTRACT
Accurate assessments of intravascular fluid status are an essential part of perioperative care and necessary in the management of the hemodynamically unstable patient. Goal-directed fluid management can facilitate resuscitation of the hypovolemic patient, reduce the risk of fluid overload, reduce the risk of the injudicious use of vasopressors and inotropes, and improve clinical outcomes. In this paper, we discuss the strengths and limitations of a spectrum of noninvasive and invasive techniques for assessing and monitoring intravascular volume status and fluid responsiveness in the perioperative and critically ill patient.

No MeSH data available.


Related in: MedlinePlus