Changes in portal pulsatility index induced by a fluid challenge in patients with haemodynamic instability and systemic venous congestion: a prospective cohort study.
Haemodynamic instability
Portal pulsatility index
Preload responsiveness
Systemic venous congestion
Ultrasound
Journal
Annals of intensive care
ISSN: 2110-5820
Titre abrégé: Ann Intensive Care
Pays: Germany
ID NLM: 101562873
Informations de publication
Date de publication:
01 Nov 2024
01 Nov 2024
Historique:
received:
09
08
2024
accepted:
06
10
2024
medline:
1
11
2024
pubmed:
1
11
2024
entrez:
1
11
2024
Statut:
epublish
Résumé
It is uncertain whether fluid administration can improve patients with systemic venous congestion and haemodynamic instability. This study aimed to describe the changes in systemic venous congestion and peripheral perfusion parameters induced by a fluid challenge in these patients, and to analyse the influence of the fluid responsiveness status on these changes. The study is a single-centre prospective cohort study of 36 critically ill ICU patients with haemodynamic instability and a maximum vena cava diameter ≥ 20 mm. Changes in cardiac index during a fluid challenge (4 mL/kg of lactated Ringer's solution during 5 min) assessed by pulse contour analysis, central venous pressure, ultrasound systemic congestion parameters (portal venous flow pulsatility index, supra hepatic and intrarenal venous Doppler), and peripheral perfusion parameters (capillary refill time and peripheral perfusion index) were assessed in the overall population. All these data were compared between patients presenting a cardiac index increase > 10% during the fluid challenge (fluid responders) and the others (fluid non-responders). Twenty-eight (78%) patients were admitted for postoperative care following cardiac surgery; their mean ± SD left ventricular ejection fraction was 42 ± 9% and right ventricular dysfunction was found in at least 61% of the patients. The mean ± SD SOFA score was 9 ± 3. Thirteen (36%) patients were fluid responders. The fluid challenge administration induced a significant increase in portal pulsatility index, VExUS score, and central venous pressure without significant difference of these changes between fluid responders and non-responders. No significant change in perfusion parameters was observed. Fluid administration in patients with haemodynamic instability and systemic venous congestion worsens venous congestion regardless of the fluid responsiveness status, without improving perfusion parameters.
Sections du résumé
BACKGROUND
BACKGROUND
It is uncertain whether fluid administration can improve patients with systemic venous congestion and haemodynamic instability. This study aimed to describe the changes in systemic venous congestion and peripheral perfusion parameters induced by a fluid challenge in these patients, and to analyse the influence of the fluid responsiveness status on these changes.
METHODS
METHODS
The study is a single-centre prospective cohort study of 36 critically ill ICU patients with haemodynamic instability and a maximum vena cava diameter ≥ 20 mm. Changes in cardiac index during a fluid challenge (4 mL/kg of lactated Ringer's solution during 5 min) assessed by pulse contour analysis, central venous pressure, ultrasound systemic congestion parameters (portal venous flow pulsatility index, supra hepatic and intrarenal venous Doppler), and peripheral perfusion parameters (capillary refill time and peripheral perfusion index) were assessed in the overall population. All these data were compared between patients presenting a cardiac index increase > 10% during the fluid challenge (fluid responders) and the others (fluid non-responders).
RESULTS
RESULTS
Twenty-eight (78%) patients were admitted for postoperative care following cardiac surgery; their mean ± SD left ventricular ejection fraction was 42 ± 9% and right ventricular dysfunction was found in at least 61% of the patients. The mean ± SD SOFA score was 9 ± 3. Thirteen (36%) patients were fluid responders. The fluid challenge administration induced a significant increase in portal pulsatility index, VExUS score, and central venous pressure without significant difference of these changes between fluid responders and non-responders. No significant change in perfusion parameters was observed.
CONCLUSION
CONCLUSIONS
Fluid administration in patients with haemodynamic instability and systemic venous congestion worsens venous congestion regardless of the fluid responsiveness status, without improving perfusion parameters.
Identifiants
pubmed: 39485575
doi: 10.1186/s13613-024-01391-2
pii: 10.1186/s13613-024-01391-2
doi:
Types de publication
Journal Article
Langues
eng
Pagination
167Informations de copyright
© 2024. The Author(s).
Références
Vincent JL, De Backer D. Circulatory shock. N Engl J Med. 2013;369(18):1726–34.
pubmed: 24171518
doi: 10.1056/NEJMra1208943
Malbrain MLNG, Marik PE, Witters I, Cordemans C, Kirkpatrick AW, Roberts DJ, et al. Fluid overload, de-resuscitation, and outcomes in critically ill or injured patients: a systematic review with suggestions for clinical practice. Anaesthesiol Intensive Ther. 2014;46(5):361–80.
pubmed: 25432556
doi: 10.5603/AIT.2014.0060
Cecconi M, De Backer D, Antonelli M, Beale R, Bakker J, Hofer C, et al. Consensus on circulatory shock and hemodynamic monitoring. Task force of the European Society of Intensive Care Medicine. Intensive Care Med. 2014;40(12):1795–815.
pubmed: 25392034
pmcid: 4239778
doi: 10.1007/s00134-014-3525-z
Evans L, Rhodes A, Alhazzani W, Antonelli M, Coopersmith CM, French C, et al. Executive summary: surviving sepsis campaign: international guidelines for the management of sepsis and septic shock 2021. Crit Care Med. 2021;49(11):1974–82.
pubmed: 34643578
doi: 10.1097/CCM.0000000000005357
Kattan E, Castro R, Miralles-Aguiar F, Hernández G, Rola P. The emerging concept of fluid tolerance: a position paper. J Crit Care. 2022;71: 154070.
pubmed: 35660844
doi: 10.1016/j.jcrc.2022.154070
Muñoz F, Born P, Bruna M, Ulloa R, González C, Philp V, et al. Coexistence of a fluid responsive state and venous congestion signals in critically ill patients: a multicenter observational proof-of-concept study. Crit Care. 2024;28(1):52.
pubmed: 38374167
pmcid: 10877871
doi: 10.1186/s13054-024-04834-1
Pesenti A, Slobod D, Magder S. The forgotten relevance of central venous pressure monitoring. Intensive Care Med. 2023;49(7):868–70.
pubmed: 37294343
doi: 10.1007/s00134-023-07101-z
Chen X, Wang X, Honore PM, Spapen HD, Liu D. Renal failure in critically ill patients, beware of applying (central venous) pressure on the kidney. Ann Intensive Care. 2018;8(1):91.
pubmed: 30238174
pmcid: 6146958
doi: 10.1186/s13613-018-0439-x
Guinot PG, Abou-Arab O, Longrois D, Dupont H. Right ventricular systolic dysfunction and vena cava dilatation precede alteration of renal function in adult patients undergoing cardiac surgery: an observational study. Eur J Anaesthesiol. 2015;32(8):535–42.
pubmed: 25192267
doi: 10.1097/EJA.0000000000000149
Deschamps J, Denault A, Galarza L, Rola P, Ledoux-Hutchinson L, Huard K, et al. Venous Doppler to assess congestion: a comprehensive review of current evidence and nomenclature. Ultrasound Med Biol. 2023;49(1):3–17.
pubmed: 36207224
doi: 10.1016/j.ultrasmedbio.2022.07.011
Abou-Arab O, Beyls C, Moussa MD, Huette P, Beaudelot E, Guilbart M, et al. Portal vein pulsatility index as a potential risk of venous congestion assessed by magnetic resonance imaging: a prospective study on healthy volunteers. Front Physiol. 2022;29(13): 811286.
doi: 10.3389/fphys.2022.811286
Huette P, Guinot PG, Haye G, Moussa MD, Beyls C, Guilbart M, et al. Portal vein pulsatility as a dynamic marker of venous congestion following cardiac surgery: an interventional study using positive end-expiratory pressure. J Clin Med. 2021;10(24):5810.
pubmed: 34945106
pmcid: 8706622
doi: 10.3390/jcm10245810
Guinot PG, Bahr PA, Andrei S, Popescu BA, Caruso V, Mertes PM, et al. Doppler study of portal vein and renal venous velocity predict the appropriate fluid response to diuretic in ICU: a prospective observational echocardiographic evaluation. Crit Care. 2022;26(1):305.
pubmed: 36199091
pmcid: 9535945
doi: 10.1186/s13054-022-04180-0
Vincent JL, Cecconi M, De Backer D. The fluid challenge. Crit Care. 2020;24(1):703.
pubmed: 33371895
pmcid: 7771055
doi: 10.1186/s13054-020-03443-y
Toulouse E, Masseguin C, Lafont B, McGurk G, Harbonn A, Roberts JA, et al. French legal approach to clinical research. Anaesth Crit Care Pain Med. 2018;37(6):607–14.
pubmed: 30580775
doi: 10.1016/j.accpm.2018.10.013
von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP, et al. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. J Clin Epidemiol. 2008;61(4):344–9.
doi: 10.1016/j.jclinepi.2007.11.008
Beaubien-Souligny W, Rola P, Haycock K, Bouchard J, Lamarche Y, Spiegel R, et al. Quantifying systemic congestion with Point-Of-Care ultrasound: development of the venous excess ultrasound grading system. Ultrasound J. 2020;12(1):16.
pubmed: 32270297
pmcid: 7142196
doi: 10.1186/s13089-020-00163-w
Vincent JL, Moreno R, Takala J, Willatts S, De Mendonça A, Bruining H, et al. The SOFA (Sepsis-related Organ Failure Assessment) score to describe organ dysfunction/failure. On behalf of the Working Group on Sepsis-Related Problems of the European Society of Intensive Care Medicine. Intensive Care Med. 1996;22(7):707–10.
pubmed: 8844239
doi: 10.1007/BF01709751
Jacquet-Lagrèze M, Pernollet A, Kattan E, Ait-Oufella H, Chesnel D, Ruste M, et al. Prognostic value of capillary refill time in adult patients: a systematic review with meta-analysis. Crit Care Lond Engl. 2023;27(1):473.
doi: 10.1186/s13054-023-04751-9
Coutrot M, Dudoignon E, Joachim J, Gayat E, Vallée F, Dépret F. Perfusion index: physical principles, physiological meanings and clinical implications in anaesthesia and critical care. Anaesth Crit Care Pain Med. 2021;40(6): 100964.
pubmed: 34687923
doi: 10.1016/j.accpm.2021.100964
Expert Round Table on Echocardiography in ICU. International consensus statement on training standards for advanced critical care echocardiography. Intensive Care Med. 2014;40(5):654–66.
doi: 10.1007/s00134-014-3228-5
Beaubien-Souligny W, Benkreira A, Robillard P, Bouabdallaoui N, Chassé M, Desjardins G, et al. Alterations in portal vein flow and intrarenal venous flow are associated with acute kidney injury after cardiac surgery: a prospective observational cohort study. J Am Heart Assoc. 2018;7(19): e009961.
pubmed: 30371304
pmcid: 6404886
doi: 10.1161/JAHA.118.009961
Jones N, Burns AT, Prior DL. Echocardiographic assessment of the right ventricle-state of the art. Heart Lung Circ. 2019;28(9):1339–50.
pubmed: 31175016
doi: 10.1016/j.hlc.2019.04.016
Dargent A, Dumargne H, Labruyère M, Brezillon S, Brassart-Pasco S, Blot M, et al. Role of the interstitium during septic shock: a key to the understanding of fluid dynamics? J Intensive Care. 2023;11(1):44.
pubmed: 37817235
pmcid: 10565984
doi: 10.1186/s40560-023-00694-z
Boyd JH, Forbes J, Nakada T, Walley KR, Russell JA. Fluid resuscitation in septic shock: a positive fluid balance and elevated central venous pressure are associated with increased mortality. Crit Care Med. 2011;39(2):259–65.
pubmed: 20975548
doi: 10.1097/CCM.0b013e3181feeb15
De Backer D, Cecconi M, Chew MS, Hajjar L, Monnet X, Ospina-Tascón GA, et al. A plea for personalization of the hemodynamic management of septic shock. Crit Care. 2022;26(1):372.
pubmed: 36457089
pmcid: 9714237
doi: 10.1186/s13054-022-04255-y
Weil MH, Henning RJ. New concepts in the diagnosis and fluid treatment of circulatory shock. Thirteenth annual Becton, Dickinson and Company Oscar Schwidetsky Memorial Lecture. Anesth Analg. 1979;58(2):124–32.
pubmed: 571235
doi: 10.1213/00000539-197903000-00013
Eskesen TG, Wetterslev M, Perner A. Systematic review including re-analyses of 1148 individual data sets of central venous pressure as a predictor of fluid responsiveness. Intensive Care Med. 2016;42(3):324–32.
pubmed: 26650057
doi: 10.1007/s00134-015-4168-4
Marik PE, Cavallazzi R. Does the central venous pressure predict fluid responsiveness? An updated meta-analysis and a plea for some common sense. Crit Care Med. 2013;41(7):1774–81.
pubmed: 23774337
doi: 10.1097/CCM.0b013e31828a25fd
Hamzaoui O, Gouëzel C, Jozwiak M, Millereux M, Sztrymf B, Prat D, et al. Increase in central venous pressure during passive leg raising cannot detect preload unresponsiveness. Crit Care Med. 2020;48(8):e684–9.
pubmed: 32697509
doi: 10.1097/CCM.0000000000004414
Longino A, Martin K, Leyba K, Siegel G, Gill E, Douglas IS, et al. Correlation between the VExUS score and right atrial pressure: a pilot prospective observational study. Crit Care Lond Engl. 2023;27(1):205.
doi: 10.1186/s13054-023-04471-0
Guyton AC, Lindsey AW, Kaufmann BN. Effect of mean circulatory filling pressure and other peripheral circulatory factors on cardiac output. Am J Physiol. 1955;180(3):463–8.
pubmed: 14376522
doi: 10.1152/ajplegacy.1955.180.3.463
Legrand M, Dupuis C, Simon C, Gayat E, Mateo J, Lukaszewicz AC, et al. Association between systemic hemodynamics and septic acute kidney injury in critically ill patients: a retrospective observational study. Crit Care Lond Engl. 2013;17(6):R278.
doi: 10.1186/cc13133
Neuman J, Schulz L, Aneman A. Associations between mean systemic filling pressure and acute kidney injury: an observational cohort study following cardiac surgery. Acta Anaesthesiol Scand. 2021;65(3):373–80.
pubmed: 33141953
doi: 10.1111/aas.13732
Levy MN. The cardiac and vascular factors that determine systemic blood flow. Circ Res. 1979;44(6):739–47.
pubmed: 428068
doi: 10.1161/01.RES.44.6.739
Monnet X, Julien F, Ait-Hamou N, Lequoy M, Gosset C, Jozwiak M, et al. Lactate and venoarterial carbon dioxide difference/arterial-venous oxygen difference ratio, but not central venous oxygen saturation, predict increase in oxygen consumption in fluid responders. Crit Care Med. 2013;41(6):1412–20.
pubmed: 23442986
doi: 10.1097/CCM.0b013e318275cece
Ospina-Tascon G, Neves AP, Occhipinti G, Donadello K, Büchele G, Simion D, et al. Effects of fluids on microvascular perfusion in patients with severe sepsis. Intensive Care Med. 2010;36(6):949–55.
pubmed: 20221744
doi: 10.1007/s00134-010-1843-3
Guinot PG, Longrois D, Andrei S, Nguyen M, Bouhemad B, CodOrea study group. Exploring congestion endotypes and their distinct clinical outcomes among ICU patients: a post-hoc analysis. Anaesth Crit Care Pain Med. 2024;43(3):101370.
pubmed: 38462160
doi: 10.1016/j.accpm.2024.101370
Mullens W, Damman K, Harjola V, Mebazaa A, Brunner-La Rocca H, Martens P, et al. The use of diuretics in heart failure with congestion—a position statement from the Heart Failure Association of the European Society of Cardiology. Eur J Heart Fail. 2019;21(2):137–55.
pubmed: 30600580
doi: 10.1002/ejhf.1369
Kotani Y, Di Gioia A, Landoni G, Belletti A, Khanna AK. An updated ‘norepinephrine equivalent’ score in intensive care as a marker of shock severity. Crit Care Lond Engl. 2023;27(1):29.
doi: 10.1186/s13054-023-04322-y
Koponen T, Karttunen J, Musialowicz T, Pietiläinen L, Uusaro A, Lahtinen P. Vasoactive-inotropic score and the prediction of morbidity and mortality after cardiac surgery. Br J Anaesth. 2019;122(4):428–36.
pubmed: 30857599
pmcid: 6435836
doi: 10.1016/j.bja.2018.12.019