title: Development of a fluid resuscitation protocol using inferior vena cava and lung ultrasound.
abstract: Appropriate fluid resuscitation has been a major focus of critical care medicine since its inception. Currently, the most accurate method to guide fluid administration decisions uses "dynamic" measures that estimate the change in cardiac output that would occur in response to a fluid bolus. Unfortunately, their use remains limited due to required technical expertise, costly equipment, or applicability in only a subset of patients. Alternatively, point-of-care ultrasound (POCUS) has become widely used as a tool to help clinicians prescribe fluid therapy. Common POCUS applications that serve as guides to fluid administration rely on assessments of the inferior vena cava to estimate preload and lung ultrasound to identify the early presence of extravascular lung water and avoid fluid overresuscitation. Although application of these POCUS measures has multiple limitations that are commonly misunderstood, current evidence suggests that they can be used in combination to sort patients among 3 fluid management categories: (1) fluid resuscitate, (2) fluid test, and (3) fluid restrict. This article reviews the pertinent literature describing the use of inferior vena cava and lung ultrasound for fluid responsiveness and presents an evidence-informed algorithm using these measures to guide fluid resuscitation decisions in the critically ill.
authors.affiliation: Division of Emergency Medicine, Department of Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada.
authors.forename: Christopher W C
authors.initials: CW
authors.lastname: Lee
authors.affiliation: Division of Allergy, Pulmonary, and Critical Care, Department of Medicine, University of Wisconsin Hospital and Clinics, Madison, WI, USA.
authors.forename: Pierre D
authors.initials: PD
authors.lastname: Kory
authors.affiliation: Division of Emergency Medicine, Department of Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada; Division of Critical Care Medicine, Department of Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada. Electronic address: robert.arntfield@gmail.com.
authors.forename: Robert T
authors.initials: RT
authors.lastname: Arntfield
mesh_terms: D002302:Cardiac Output / Q000502:physiology; D002985:Clinical Protocols; D003422:Critical Care / Q000379:methods; D016638:Critical Illness / Q000628:therapy; D015633:Extravascular Lung Water / Q000000981:diagnostic imaging*; D005440:Fluid Therapy / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D008168:Lung / Q000000981:diagnostic imaging*; D019095:Point-of-Care Systems; D017410:Practice Guidelines as Topic; D012151:Resuscitation / Q000379:methods*; D012769:Shock / Q000628:therapy*; D014463:Ultrasonography; D014682:Vena Cava, Inferior / Q000000981:diagnostic imaging*
keywords: Critical care; Decision making; Resuscitation; Shock; Ultrasound