• Hemorrhage
• Perfusion index
• Pleth variability index
• Ultrasonography
• Vena cava inferior

• Heart-lung interaction
• Intensive care
• Multiple organ failure
• Preload dependency
• Volume responsiveness

• Humans
• Hemodynamic Monitoring/methods
• Critical Care/methods
• Hemodynamics/physiology
• Stroke Volume/physiology
• Monitoring, Physiologic/methods
• Respiration, Artificial

• Doppler ultrasound
• corrected flow time
• fluid responsiveness
• gynecologic surgery
• robotic-assisted

• Chongqing Municipal Education Commission

• Caval index
• Dehydration
• Drug overdose
• Fluid resuscitation

• Humans
• Dehydration
• Prospective Studies
• Fluid Therapy
• Blood Pressure
• Emergency Service, Hospital
• Vena Cava, Inferior/physiology

• Acute blood loss
• Early diagnosis
• Mitral annular plane systolic excursion
• Tricuspid annular plane systolic excursion

• Humans
• Healthy Volunteers
• Echocardiography
• Systole
• Tricuspid Valve/diagnostic imaging
• Heart Rate

• No sources of funding

• Hemorragic shck
• Hypovolemia
• IVC diameter
• TAPSE
• Ultrasonography

Determining whether a patient in shock is in a state of fluid responsiveness (FR) has long been the Holy Grail for clinicians who care for acutely ill patients. While various tools have been put forth as solutions to this important problem, ultrasound assessment of the inferior vena cava has received particular attention of late. Dozens of studies have examined its ability to determine whether a patient should receive volume expansion, and general enthusiasm has been strengthened by the fact that it is easy to perform and non-invasive, unlike many competing FR tests. A deeper examination of the technique, however, reveals important concerns regarding inaccuracies in measurement and a high prevalence of confounding factors. Furthermore, a detailed review of the evidence (small individual studies, multiple meta-analyses, and a single large trial) reveals that the tool performs poorly in general and is unlikely to be helpful at the bedside in circumstances where genuine clinical uncertainty exists.

• fluid therapy
• intensive care
• shock
• ultrasound

• Inferior vena cava distensibility
• Mechanical ventilation
• PEEP
• Tidal volume

• POCUS
• carotid VTi
• emergency medicine training
• fluid responsiveness
• fluid resuscitation
• haemodynamics
• shock
• ultrasonography

• abdominal aorta
• emergency medicine
• hypovolemic shock
• inferior vena cava
• trauma
• ultrasound

• Adolescent
• Adult
• Aorta, Abdominal/diagnostic imaging
• Blood Donors
• Blood Volume
• Female
• Healthy Volunteers
• Humans
• Male
• Middle Aged
• Prospective Studies
• Resuscitation
• Shock/diagnostic imaging
• Shock/physiopathology
• Vena Cava, Inferior/diagnostic imaging

• bun/creatinine ratio
• collabsibility index
• dehydration
• hip fracture
• inferior vena cava diameter

• Aged
• Aged, 80 and over
• Area Under Curve
• Biomarkers/blood
• Blood Urea Nitrogen
• Creatinine/blood
• Dehydration/diagnosis
• Female
• Hip Fractures/blood
• Hip Fractures/diagnostic imaging
• Hip Fractures/surgery
• Humans
• Male
• Middle Aged
• Organ Size
• Preoperative Care
• Prospective Studies
• ROC Curve
• Ultrasonography
• Vena Cava, Inferior/diagnostic imaging
• Vena Cava, Inferior/pathology

There is little published data investigating non-invasive cardiac output monitoring in the emergency department (ED). We assessed six non-invasive fluid responsiveness monitoring methods which measure cardiac output directly or indirectly for their feasibility and repeatability of measurements in the ED: (1) left ventricular outflow tract echocardiography derived velocity time integral, (2) common carotid artery blood flow, (3) suprasternal aortic Doppler, (4) bioreactance, (5) plethysmography with digital vascular unloading method, and (6) inferior vena cava collapsibility index.

This is a prospective observational study of non-invasive methods of assessing fluid responsiveness in the ED. Participants were non-ventilated ED adult patients requiring intravenous fluid resuscitation. Feasibility of each method was determined by the proportion of clinically interpretable measurements from the number of measurement attempts. Repeatability was determined by comparing the mean difference of two paired measurements in a fluid steady state (after participants received an intravenous fluid bolus).

76 patients were recruited in the study. A total of 207 fluid responsiveness measurement sets were analysed. Feasibility rates were 97.6% for bioreactance, 91.3% for vascular unloading method with plethysmography, 87.4% for common carotid artery blood flow, 84.1% for inferior vena cava collapsibility index, 78.7% for LVOT VTI, and 76.8% for suprasternal aortic Doppler. The feasibility rates difference between bioreactance and all other methods was statistically significant.

Our study shows that non-invasive fluid responsiveness monitoring in the emergency department may be feasible with selected methods. Higher repeatability of measurements were observed in non-ultrasound methods. These findings have implications for further studies specifically assessing the accuracy of such non-invasive cardiac output methods and their effect on patient outcome in the ED in fluid depleted states such as sepsis.

The online version of this article (10.1186/s13049-019-0586-6) contains supplementary material, which is available to authorized users.

• Bioreactance
• Fluid responsiveness
• Plethysmography
• Sepsis
• Stroke volume
• Ultrasound

• Abdominal aorta
• Hypovolemic shock
• Inferior vena cava
• Ultrasound

• bradycardia
• hypotension
• inferior vena cava
• intravascular volume
• spinal anesthesia

• Aged
• Anesthesia, Spinal/adverse effects
• Arthroplasty, Replacement, Knee/adverse effects
• Bradycardia/chemically induced
• Bradycardia/diagnostic imaging
• Elective Surgical Procedures/adverse effects
• Female
• Humans
• Hypotension/chemically induced
• Hypotension/diagnostic imaging
• Intraoperative Complications/chemically induced
• Intraoperative Complications/diagnostic imaging
• Male
• Middle Aged
• Predictive Value of Tests
• Prospective Studies
• ROC Curve
• Ultrasonography/methods
• Ultrasonography/statistics & numerical data
• Vena Cava, Inferior/diagnostic imaging

• ultrasound
• ventilation, non invasive

• cardiac output
• child
• fluid therapy
• inferior vena cava
• observational study
• sepsis

• fluid responsiveness
• inferior vena cava
• meta-analysis
• review

• Humans
• Critical Illness
• Echocardiography
• Fluid Therapy
• Pulse Wave Analysis
• Resuscitation
• Shock, Surgical/diagnosis
• Shock, Surgical/therapy
• Shock, Traumatic/diagnosis
• Shock, Traumatic/therapy

• Femoral vein collapsibility
• Fluid responsivity
• Inferior vena cava collapsibility
• Mechanical ventilation
• Septic shock

Dynamic measures, the response to stroke volume (SV) to fluid loading, have been used successfully to guide fluid management decisions in critically ill patients. However, application of dynamic measures is often inaccurate to predict fluid responsiveness in patients with arrhythmias, ventricular dysfunction or spontaneously breathing critically ill patients. Passive leg raising (PLR) is a simple bedside maneuver that may provide an accurate alternative to guide fluid resuscitation in hypovolemic critically ill patients.

Pertinent medical literature for fluid responsiveness in the critically ill patient published in English was searched over the past three decades, and then the search was extended as linked citations indicated.

Thirty-three studies including observational studies, randomized control trials, systemic review, and meta-analysis studies evaluating fluid responsiveness in the critically ill patient met selection criteria.

PLR coupled with real-time SV monitors is considered a simple, noninvasive, and accurate method to determine fluid responsiveness in critically ill patients with high sensitivity and specificity for a 10% increase in SV. The adverse effect of albumin on the mortality of head trauma patients and chloride-rich crystalloids on mortality and kidney function needs to be considered when choosing the type of fluid for resuscitation.

• Colloids
• critically ill patients
• crystalloids
• fluid responsiveness
• passive leg raising
• stroke volume

Intravenous fluid management of trauma patients is fraught with complex decisions that are often complicated by coagulopathy and blood loss. This review discusses the fluid management in trauma patients from the perspective of the developing world. In addition, the article describes an approach to specific circumstances in trauma fluid decision-making and provides recommendations for the resource-limited environment.

• Fluid responsiveness
• Inferior vena cava collapsibility
• Point-of-care ultrasound
• Spontaneously breathing

• Administration, Intravenous
• Adult
• Aged
• Critical Illness/therapy
• Female
• Fluid Therapy/methods
• Humans
• Male
• Middle Aged
• Point-of-Care Systems
• Prospective Studies
• Resuscitation/methods
• Ultrasonography/methods
• Vena Cava, Inferior/diagnostic imaging
• Vena Cava, Inferior/physiopathology

• critically ill
• intensive care unit
• nutritional support
• sepsis
• systemic inflammatory response syndrome

• Adrenal Cortex Hormones/therapeutic use
• Anti-Infective Agents/therapeutic use
• Disease Management
• Humans
• Meta-Analysis as Topic
• Randomized Controlled Trials as Topic
• Sepsis/diagnosis
• Sepsis/drug therapy
• Sepsis/physiopathology
• Vasoconstrictor Agents/therapeutic use

• Cardiac output
• Emergency
• Fluid responsiveness
• Fluid therapy
• Haemodynamics
• Resuscitation
• Shock

• Adult
• Emergency Service, Hospital
• Fluid Therapy
• Hemodynamics
• Humans

Intravascular volume status is an important clinical consideration in the management of the critically ill. Point-of-care ultrasonography (POCUS) has gained popularity as a non-invasive means of intravascular volume assessment via examination of the inferior vena cava (IVC). However, there are limited data comparing different acquisition techniques for IVC measurement by POCUS. The goal of this evaluation was to determine the reliability of three IVC acquisition techniques for volume assessment: sub-xiphoid transabdominal long axis (LA), transabdominal short axis (SA), and right lateral transabdominal coronal long axis (CLA) (aka “rescue view”).

Volunteers were evaluated by three experienced emergency physician sonographers (EP). Gray scale (B-mode) and motion-mode (M-mode) diameters were measured and IVC collapsibility index (IVCCI) calculated for three anatomic views (LA, SA, CLA). For each IVC measurement, we calculated descriptive statistics, intra-class correlation coefficients (ICC), and two-way univariate analyses of variance.

EPs evaluated 39 volunteers, yielding 351 total US measurements. Measurements of the three views had similar means (LA 1.9 ± 0.4cm; SA 1.9 ± 0.4cm; CLA 2.0 ± 0.5cm). For B-Mode, LA had the highest ICC (0.86, 95% CI [0.76–0.92]) while CLA had the poorest ICC (0.74, 95% CI [0.56–0.85]). ICCs for all M-mode IVCCI were low. Significant interaction effects between anatomical view and EP were observed for B-mode and M-mode measurements. Post-hoc analyses revealed difficulty in consistent view acquisition between EPs.

Inter-rater reliability of the IVC by EPs was highest for B-mode LA and poorest for all M-Mode IVC collapsibility indices (IVCCI). These results suggest that B-mode LA holds the most promise to deliver reliable measures of IVC diameter. Future studies may focus on validation in a clinical setting as well as comparison to a reference standard.

• Cirrhosis
• End-stage renal disease
• Obesity
• Pregnancy
• Sepsis

In patients with acute circulatory failure, the decision to give fluids or not should not be taken lightly. The risk of overzealous fluid administration has been clearly established. Moreover, volume expansion does not always increase cardiac output as one expects. Thus, after the very initial phase and/or if fluid losses are not obvious, predicting fluid responsiveness should be the first step of fluid strategy. For this purpose, the central venous pressure as well as other “static” markers of preload has been used for decades, but they are not reliable. Robust evidence suggests that this traditional use should be abandoned. Over the last 15 years, a number of dynamic tests have been developed. These tests are based on the principle of inducing short-term changes in cardiac preload, using heart–lung interactions, the passive leg raise or by the infusion of small volumes of fluid, and to observe the resulting effect on cardiac output. Pulse pressure and stroke volume variations were first developed, but they are reliable only under strict conditions. The variations in vena caval diameters share many limitations of pulse pressure variations. The passive leg-raising test is now supported by solid evidence and is more frequently used. More recently, the end-expiratory occlusion test has been described, which is easily performed in ventilated patients. Unlike the traditional fluid challenge, these dynamic tests do not lead to fluid overload. The dynamic tests are complementary, and clinicians should choose between them based on the status of the patient and the cardiac output monitoring technique. Several methods and tests are currently available to identify preload responsiveness. All have some limitations, but they are frequently complementary. Along with elements indicating the risk of fluid administration, they should help clinicians to take the decision to administer fluids or not in a reasoned way.

• Cardiac preload
• Critical care
• Echocardiography
• Fluid responsiveness
• Fluid therapy
• Haemodynamic monitoring
• Heart–lung interactions
• ICU
• Operating room
• Passive leg raising
• Pulse contour analysis
• Pulse pressure variation
• Stroke volume
• Stroke volume variation
• Volume expansion

• Cardiac index
• Carotid Doppler
• Circulating volume
• Fluid resuscitation
• Inferior vena cava
• Passive leg raise

• Aged
• Cardiac Output/physiology
• Carotid Arteries/diagnostic imaging
• Carotid Arteries/physiopathology
• Female
• Follow-Up Studies
• Healthy Volunteers
• Humans
• Intensive Care Units
• Leg/blood supply
• Male
• Middle Aged
• Pilot Projects
• Prospective Studies
• Regional Blood Flow/physiology
• Resuscitation/methods
• Ultrasonography, Doppler/methods
• Vena Cava, Inferior/diagnostic imaging
• Vena Cava, Inferior/physiopathology

• Isaac Schapera Trust for Medical research

Rapid and accurate diagnosis and treatment are paramount in the management of the critically ill. Critical care ultrasound has been widely used as an adjunct to standard clinical examination, an invaluable extension of physical examination to guide clinical decision-making at bedside. Recently, there is growing interest in the use of multi-organ point-of-care ultrasound (MOPOCUS) for the management of the critically ill, especially in the early phase of resuscitation. This article will review the role and utility of symptom-based and sign-oriented MOPOCUS in patients with undifferentiated respiratory difficulty, chest pain, or shock and how it can be performed in a timely, effective, and efficient manner.

• Chest pain
• Multi-organ point-of-care ultrasound
• Respiratory difficulty
• Shock