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Tung-Chen Y, Beltrán Robles M, Rubio Gracia J, García de Casasola Sánchez G, Llàcer Iborra P, García Rubio S, Méndez Bailón M, Montero Hernández E, Sánchez-Marteles M, Torres Arrese M, Torres Macho J, Pérez Silvestre J. Position statement on the use of point-of-care ultrasound in heart failure: recommendations from the Heart Failure and Atrial Fibrillation, and Clinical Ultrasound Working Groups of the Spanish Society of Internal Medicine (SEMI). Rev Clin Esp 2025; 225:148-156. [PMID: 39863068 DOI: 10.1016/j.rceng.2025.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2024] [Accepted: 08/21/2024] [Indexed: 01/27/2025]
Abstract
This document provides a comprehensive analysis of the use of point-of-care ultrasound in heart failure (HF), offering detailed recommendations on echocardiography, lung ultrasound, and venous ultrasound. These advanced imaging techniques allow for an accurate, detailed, and non-invasive evaluation of heart failure, facilitating rapid and effective clinical decision-making. Echocardiography enables a rapid assessment of cardiac function at the point of care, enhancing traditional physical examination and being essential for the management of heart failure (HF). Lung ultrasound provides a detailed view of the pulmonary status, crucial for diagnosing pulmonary congestion without using ionizing radiation, ideal for continuous monitoring. Venous ultrasound evaluates systemic congestion by measuring the inferior vena cava and other parameters, aiding in the estimation of right atrial pressure and monitoring pressure and volume overload, improving patient understanding and prognosis. Together, the use of these ultrasound modalities not only complements but enriches the traditional physical examination, establishing themselves as indispensable tools in the comprehensive and effective management of patients with heart failure. By incorporating these techniques into clinical practice, healthcare professionals can achieve better evaluation, diagnosis, and treatment, resulting in more personalized management of these patients.
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Affiliation(s)
- Y Tung-Chen
- Grupo de Trabajo de Ecografía Clínica de la SEMI (GTEco-SEMI); Servicio de Medicina Interna, Hospital Universitario la Paz, Madrid, Spain.
| | - M Beltrán Robles
- Servicio de Medicina Interna, Hospital Virgen del Camino, Sanlúcar de Barrameda, Cádiz; Grupo de trabajo de InsuficienciaCardíaca Y Fibrilación Auricular de la SEMI (ICYFA), Spain.
| | - J Rubio Gracia
- Servicio de Medicina Interna, Hospital Clínico Universitario Lozano Blesa, Zaragoza; Grupo de trabajo de Insuficiencia CardíacaY Fibrilación Auricular de la SEMI (ICYFA), Spain.
| | - G García de Casasola Sánchez
- Servicio de Urgencias, Hospital Universitario Fundación Alcorcón, Madrid; Grupo de trabajo de Ecografía Clínica de la SEMI(GTEco-SEMI), Spain.
| | - P Llàcer Iborra
- Servicio de Medicina Interna, Hospital Universitario Ramón y Cajal, Madrid; Grupo de trabajo de Insuficiencia Cardíaca YFibrilación Auricular de la SEMI (ICYFA), Spain.
| | - S García Rubio
- Servicio de Medicina Interna, Hospital Santa Marina, Bilbao; Grupo de trabajo de Ecografía Clínica de la SEMI (GTEco-SEMI), Spain.
| | - M Méndez Bailón
- Servicio de Medicina Interna, Hospital Universitario Clínico San Carlos, Facultad de Medicina, Universidad Complutense deMadrid, Instituto de Investigación Sanitaria Hospital Clínico San Carlos (IDISSC), Madrid; Grupo de trabajo de InsuficienciaCardíaca Y Fibrilación Auricular de la SEMI (ICYFA) y Grupo de trabajo de Ecografía Clínica de la SEMI (GTEco-SEMI), Spain.
| | - E Montero Hernández
- Servicio de Medicina Interna, Hospital Universitario Puerta de Hierro-Majadahonda, Madrid; Grupo de trabajo de InsuficienciaCardíaca Y Fibrilación Auricular de la SEMI (ICYFA) y Grupo de trabajo de Ecografía Clínica de la SEMI (GTEco-SEMI), Spain.
| | - M Sánchez-Marteles
- Servicio de Medicina Interna, Hospital Clínico Universitario Lozano Blesa, Zaragoza; Grupo de trabajo de Insuficiencia Cardíaca yFibrilación Auricular de la SEMI (ICYFA), Spain.
| | - M Torres Arrese
- Servicio de Urgencias, Hospital Universitario Fundación Alcorcón, Madrid; Grupo de trabajo de Insuficiencia Cardíaca YFibrilación Auricular de la SEMI (ICYFA), Spain.
| | - J Torres Macho
- Servicio de Medicina Interna, Hospital Universitario Infanta Leonor; Grupo de trabajo de Ecografía Clínica de la SEMI(GTEco-SEMI), Spain.
| | - J Pérez Silvestre
- Servicio de Medicina Interna, Consorcio Hospital Universitario General de Valencia; Grupo de trabajo de Insuficiencia Cardíaca y Fibrilación Auricular de la SEMI (ICYFA), Spain.
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Privitera D, Giustivi D, Langer T, Fiorina E, Gotti F, Rossini M, Brunoni B, Capsoni N, Dal Molin A, Zadek F. Effect of different sealing caps on the backflow of short-term dialysis catheters: A bench study. J Vasc Access 2024:11297298241301508. [PMID: 39643947 DOI: 10.1177/11297298241301508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/09/2024] Open
Abstract
BACKGROUND Needle-free connectors (NFCs) are recommended as closure systems for peripheral and central vascular catheters to reduce needlestick injuries and infections, while potentially reducing blood reflux. However, their performance in short-term dialysis catheters has never been evaluated. The aim of this study was to evaluate the backflow associated with two NFCs (Neutron™ and Tego™) compared to the standard closure. METHODS In this bench study, the physiological blood pressure of the superior vena cava was simulated. Expert operators performed three sealing sequences for each combination of connector and lumens of the catheter, with and without closing the clamp. After that, the backflow was measured in millimeters using a high-precision digital caliper. RESULTS No combination of caps, lumens, or clamping sequences eliminated the backflow. No differences were observed between standard caps and NFCs in both lumens, apart from the Tego™/No clamp combination in the proximal lumen that showed higher backflow (standard cap 15 [11; 17] mm vs Tego™ 23 [19; 25] mm, p < 0.001). Clamping reduced backflow in both the proximal (13 [11; 17] mm vs 20 [13; 25] mm) and distal lumens (12 [11; 16] mm vs 14 [12; 17] mm). No differences were found between standard caps and NFCs in the distal lumen, regardless of clamping. Proximal lumen consistently exhibited larger backflow (14 [12; 22] mm) compared to distal lumens (13 [11; 17] mm, p = 0.005). CONCLUSION NFCs do not seem to introduce any advantage on backflow reduction as compared to a standard cap combined with lumen and clamping. Our data suggest that clamping should become standard practice when NFCs are used in the management of short-term dialysis catheters.
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Affiliation(s)
- Daniele Privitera
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
- Department of Cardiovascular, Neural and Metabolic Sciences, Istituto Auxologico Italiano, IRCCS, San Luca Hospital, Milan, Italy
| | - Davide Giustivi
- Post Anesthesia Care Unit, Vascular Access Team ASST Lodi, Lodi, Italy
| | - Thomas Langer
- Department of Medicine and Surgery, University of Milan-Bicocca, Monza, Italy
| | - Elisabetta Fiorina
- Department of Nephrology, University Maggiore della Carità Hospital, Novara, Italy
| | - Federica Gotti
- Department of Emergency and Intensive Care, University Maggiore della Carità Hospital, Novara, Italy
| | - Michela Rossini
- Department of Emergency Medicine, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Beatrice Brunoni
- Department of Medicine and Surgery, University of Milan-Bicocca, Monza, Italy
| | - Nicolò Capsoni
- Department of Medicine and Surgery, University of Milan-Bicocca, Monza, Italy
- Department of Emergency Medicine, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Alberto Dal Molin
- Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy
- Health Professions' Direction, Maggiore della Carità Hospital, Novara, Italy
| | - Francesco Zadek
- Department of Medicine and Surgery, University of Milan-Bicocca, Monza, Italy
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Keskinis C, Panagoutsos S, Soilemezi E, Pateinakis P, Kyriklidou P, Memmos E, Papadopoulou D, Passadakis P. A nephrology trainee can define the fluid status through lung ultrasonography and inferior vena cava measurements in hemodialysis patients: an observational study in a single center. J Ultrasound 2024; 27:887-894. [PMID: 38867096 PMCID: PMC11496488 DOI: 10.1007/s40477-024-00903-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 04/09/2024] [Indexed: 06/14/2024] Open
Abstract
AIMS The determination of ideal weight in hemodialysis patients remains a common problem. The use of Lung Ultrasound (LUS) is an emerging method of assessing the hydric status of hemodialysis patients. LUS combined with Inferior Vena Cava (IVC) ultrasonography can define the fluid status in hemodialysis patients. METHODS This study included 68 hemodialysis patients from the Dialysis Unit of Papageorgiou General Hospital in Thessaloniki. The patients underwent lung and IVC ultrasound 30 min before and after the end of the dialysis session by a nephrology trainee. Patients' ideal weight was modified based on daily clinical practice rather than ultrasound findings. The presence of B lines and ultrasound findings of the IVC were evaluated. RESULTS The average B line score was 11.53 ± 5.02 before dialysis and became 5.57 ± 3.14 after the session. The average diameter of the IVC was 14.266 ± 0.846 mm before dialysis and 12.328 ± 0.879 mm after the session. The patients were categorized based on the magnitude of overhydration and the findings were evaluated. In addition, findings after the session showed a statistically significant correlation between the b line score and the diameter of the IVC adjusted for the body surface area. (p = 0.009 < 0.05). CONCLUSIONS A high rate of hyperhydration was detected before the dialysis session (25%). While it is the first study conducted by a nephrology trainee highlighting that it is a feasible technique. Intervention studies should be carried out in the future to draw more precise conclusions.
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Affiliation(s)
- Christodoulos Keskinis
- Department of Nephrology, Papageorgiou General Hospital, Thessaloniki, Greece.
- Medical School, Democritus University of Thrace, Alexandroupolis, Greece.
| | - Stylianos Panagoutsos
- Medical School, Democritus University of Thrace, Alexandroupolis, Greece
- Department of Nephrology, University Hospital of Alexandroupolis, Alexandroupolis, Greece
| | - Eleni Soilemezi
- Intensive Care Unit, Papageorgiou Hospital, Thessaloniki, Greece
| | | | - Parthena Kyriklidou
- Department of Nephrology, Papageorgiou General Hospital, Thessaloniki, Greece
| | - Evangelos Memmos
- Department of Nephrology, Papageorgiou General Hospital, Thessaloniki, Greece
| | | | - Ploumis Passadakis
- Medical School, Democritus University of Thrace, Alexandroupolis, Greece
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Wang MK, Piticaru J, Kappel C, Mikhaeil M, Mbuagbaw L, Rochwerg B. Internal jugular vein ultrasound for the diagnosis of hypovolemia and hypervolemia in acutely ill adults: a systematic review and meta-analysis. Intern Emerg Med 2022; 17:1521-1532. [PMID: 35718838 DOI: 10.1007/s11739-022-03003-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Accepted: 05/10/2022] [Indexed: 11/05/2022]
Abstract
Accurate volume status assessments allow physicians to rapidly implement therapeutic measures in acutely unwell patients. However, existing bedside diagnostic tools are often unreliable for assessing intravascular volume. We searched PUBMED, EMBASE, CENTRAL, and Web of Science for English language articles without date restrictions on January 20, 2022. Studies reporting the diagnostic accuracy of IJV-US for hypovolemia and/or hypervolemia in an acute care setting were screened for inclusion. We included studies using any method of IJV-US assessment as the index test, compared against any reference standard. We fitted hierarchical summary receiver operating characteristic (HSROC) models for meta-analysis of diagnostic test accuracy, separately for hypovolemia and hypervolemia. Two reviewers independently extracted data and assessed risk of bias using QUADAS-2. We assessed certainty of evidence using the GRADE approach. A total of 26 studies were included, of which 19 studies (956 patients) examined IJV-US for hypovolemia and 13 studies (672 patients) examined IJV-US for hypervolemia. For the diagnosis of hypovolemia, IJV-US had a pooled sensitivity of 0.82 (95% CI 0.76 to 0.87; moderate-certainty evidence) and specificity of 0.82 (95% CI 0.73 to 0.88; moderate-certainty evidence). Measurement of IJV collapsibility indices had higher diagnostic accuracy (sensitivity 0.85, 95% CI 0.80 to 0.89; specificity 0.78, 95% CI 0.64 to 0.88) than static IJV indices (sensitivity 0.73, 95% CI 0.60 to 0.82; specificity 0.70, 95% CI 0.48 to 0.86). For the diagnosis of hypervolemia, IJV-US had a pooled sensitivity of 0.84 (95% CI 0.70 to 0.92; moderate-certainty evidence) and specificity of 0.70 (95% CI 0.55 to 0.82; very low-certainty evidence). IJV-US has moderate sensitivity and specificity for the diagnosis of hypervolemia and hypovolemia. Randomized controlled trials are needed to determine the role of IJV-US for guiding therapeutic interventions aimed at optimizing volume status.
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Affiliation(s)
- Michael Ke Wang
- Department of Medicine, McMaster University, Hamilton, Canada.
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Canada.
- Population Health Research Institute, McMaster University, 237 Barton Street East, Hamilton, ON, Canada.
| | - Joshua Piticaru
- Department of Medicine, St. Joseph's Hospital, Syracuse, NY, USA
| | - Coralea Kappel
- Department of Medicine, McMaster University, Hamilton, Canada
| | | | - Lawrence Mbuagbaw
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Canada
- Department of Anesthesia, McMaster University, Hamilton, Canada
- Biostatistics Unit, Father Sean O'Sullivan Research Centre, St Joseph's Healthcare, Hamilton, Canada
- Centre for Development of Best Practices in Health (CDBPH), Yaoundé Central Hospital, Yaoundé, Cameroon
- Department of Global Health, Stellenbosch University, Cape Town, South Africa
| | - Bram Rochwerg
- Department of Medicine, McMaster University, Hamilton, Canada
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Canada
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Ravi KS, Espersen C, Curtis KA, Cunningham JW, Jering KS, Prasad NG, Platz E, Mc Causland FR. Temporal Changes in Electrolytes, Acid-Base, QTc Duration, and Point-of-Care Ultrasound during Inpatient Hemodialysis Sessions. KIDNEY360 2022; 3:1217-1227. [PMID: 35919528 PMCID: PMC9337888 DOI: 10.34067/kid.0001652022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 05/09/2022] [Indexed: 02/02/2023]
Abstract
Background Of the more than 550,000 patients receiving maintenance hemodialysis (HD) in the United States, each has an average of 1.6 admissions annually (>880,000 inpatient HD sessions). Little is known about the temporal changes in laboratory values, ECGs, and intravascular and extravascular volume during inpatient HD sessions. Methods In this prospective cohort study of hospitalized HD patients, we assessed intradialytic laboratory values (metabolic panels, blood gases, ionized calcium levels), ECGs, and sonographic measures of volume status. Results Among 30 participants undergoing HD (mean age 62 years; 53% men, 43% Black) laboratory values had the largest changes in the first hour of HD. There was no significant change in ionized calcium levels pre- to post-HD (change: -0.01±0.07, P=0.24); 12 of 30 and 17 of 30 patients had levels below the lower reference limit at the beginning and end of HD, respectively. The mean pH increased pre- to post-HD (change: 0.06±0.04, P<0.001); 21 of 30 had a pH above the upper reference limit post-HD. There was a trend toward longer median QTc duration from pre- to post-HD (change: 7.5 msec [-5 msec, 19 msec], P=0.07). The sum of B lines on lung ultrasound decreased from pre- to post-HD (median decrease: 3 [1, 7], P<0.01). The collapsibility index of the inferior vena cava increased pre- to post-HD (median increase: 4.8% [1.5%, 13.4%], P=0.01), whereas internal jugular vein diameter did not change (P=0.24). Conclusions Among hospitalized patients undergoing HD, we found dynamic changes in laboratory values, QTc duration, and volume status. Further research is required to assess whether HD prescriptions can be tailored to alter these variations to potentially improve patient outcomes.
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Affiliation(s)
- Katherine Scovner Ravi
- Renal Division, Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts,Harvard Medical School, Boston, Massachusetts
| | - Caroline Espersen
- Cardiovascular Division, Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts,Cardiovascular Noninvasive Imaging Research Laboratory, Department of Cardiology, Herlev and Gentofte Hospital, Copenhagen, Denmark
| | - Katherine A. Curtis
- Renal Division, Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts,Harvard Medical School, Boston, Massachusetts
| | - Jonathan W. Cunningham
- Harvard Medical School, Boston, Massachusetts,Cardiovascular Division, Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Karola S. Jering
- Harvard Medical School, Boston, Massachusetts,Cardiovascular Division, Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Narayana G. Prasad
- Harvard Medical School, Boston, Massachusetts,Cardiovascular Division, Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Elke Platz
- Harvard Medical School, Boston, Massachusetts,Cardiovascular Division, Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Finnian R. Mc Causland
- Renal Division, Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts,Harvard Medical School, Boston, Massachusetts
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Ma Z, Gai J, Sun Y, Bai Y, Cai H, Wu L, Sun L, Liu J, Xue L, Liu B. Measuring the ratio of femoral vein diameter to femoral artery diameter by ultrasound to estimate volume status. BMC Cardiovasc Disord 2021; 21:506. [PMID: 34670503 PMCID: PMC8527729 DOI: 10.1186/s12872-021-02309-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 10/05/2021] [Indexed: 12/26/2022] Open
Abstract
Background Currently, the accepted effective method for assessing blood volume status, such as measuring central venous pressure (CVP) and mean pulmonary artery pressure (mPAP), is invasive. The purpose of this study was to explore the feasibility and validity of the ratio of the femoral vein diameter (FVD) to the femoral artery diameter (FAD) for predicting CVP and mPAP and to calculate the cut-off value for the FVD/FAD ratio to help judge a patient’s fluid volume status. Methods In this study, 130 patients were divided into two groups: in group A, the FVD, FAD, and CVP were measured, and in group B, the FVD, FAD, and mPAP were measured. We measured the FVD and FAD by ultrasound. We monitored CVP by a central venous catheter and mPAP by a Swan-Ganz floating catheter. Pearson correlation coefficients were calculated. The best cut-off value for the FVD/FAD ratio for predicting CVP and mPAP was obtained according to the receiver operating characteristic (ROC) curve. Results The FVD/FAD ratio was strongly correlated with CVP (R = 0.87, P < 0.0000) and mPAP (R = 0.73, P < 0.0000). According to the ROC curve, an FVD/FAD ratio ≥ 1.495 had the best test characteristics to predict a CVP ≥ 12 cmH2O, and an FVD/FAD ratio ≤ 1.467 had the best test characteristics to predict a CVP ≤ 10 cmH2O. An FVD/FAD ratio ≥ 2.03 had the best test characteristics to predict an mPAP ≥ 25 mmHg. According to the simple linear regression curve of the FVD/FAD ratio and CVP, when the predicted CVP ≤ 5 cmH2O, the FVD/FAD ratio was ≤ 0.854. Conclusion In this study, the measurement of the FVD/FAD ratio obtained via ultrasound was strongly correlated with CVP and mPAP, providing a non-invasive method for quickly and reliably assessing blood volume status and providing good clinical support.
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Affiliation(s)
- Zhihang Ma
- Department of Cardiology, The Fourth Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
| | - Jiaxin Gai
- Department of Cardiology, The Fourth Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
| | - Yinghan Sun
- Department of Cardiology, The Fourth Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
| | - Yunpeng Bai
- Department of Cardiology, The Fourth Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
| | - Hongyi Cai
- Department of Cardiology, The Fourth Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
| | - Lei Wu
- Department of Cardiology, The Fourth Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
| | - Lixiu Sun
- Department of Cardiology, The Fourth Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
| | - Junyan Liu
- Department of Cardiology, The Fourth Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
| | - Li Xue
- Department of Cardiology, The Fourth Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
| | - Bingchen Liu
- Department of Cardiology, The Fourth Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China.
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Safadi S, Murthi S, Kashani KB. Use of Ultrasound to Assess Hemodynamics in Acutely Ill Patients. KIDNEY360 2021; 2:1349-1359. [PMID: 35369668 PMCID: PMC8676393 DOI: 10.34067/kid.0002322021] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Accepted: 06/01/2021] [Indexed: 02/04/2023]
Abstract
Early diagnosis of AKI and preventive measures can likely decrease the severity of the injury and improve patient outcomes. Current hemodynamic monitoring variables, including BP, heart and respiratory rates, temperature, and oxygenation status, have been used to identify patients at high risk for AKI. Despite the widespread use of such variables, their ability to accurately and timely detect patients who are high risk has been questioned. Therefore, there is a critical need to develop and validate tools that can measure new and more kidney-specific hemodynamic and laboratory variables, potentially assisting with AKI risk stratification, implementing appropriate and timely preventive measures, and hopefully improved outcomes. The new ultrasonography techniques provide novel insights into kidney hemodynamics and potential management and/or therapeutic targets. Contrast-enhanced ultrasonography; Doppler flow patterns of hepatic veins, portal vein, and intrakidney veins; and ultrasound elastography are among approaches that may provide such information, particularly related to vascular changes in AKI, venous volume excess or congestion, and fluid tolerance. This review summarizes the current state of these techniques and their relevance to kidney hemodynamic management.
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Affiliation(s)
- Sami Safadi
- Division of Critical Care Medicine, Alteon Health, Carroll Hospital, Westminster, Maryland
| | - Sarah Murthi
- Division of Trauma and Surgical Critical Care, Department of Surgery, University of Maryland School of Medicine, Baltimore, Maryland
| | - Kianoush B. Kashani
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, Minnesota,Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic, Rochester, Minnesota
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Koratala A, Teodorescu V, Niyyar VD. The Nephrologist as an Ultrasonographer. Adv Chronic Kidney Dis 2020; 27:243-252. [PMID: 32891309 DOI: 10.1053/j.ackd.2020.03.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Revised: 02/17/2020] [Accepted: 03/05/2020] [Indexed: 02/07/2023]
Abstract
Ultrasonography is increasingly being used in the practice of nephrology, whether it is for diagnosis or management of acute or chronic kidney dysfunction, until progression to end-stage kidney disease, including preoperative assessment, access placement, and diagnosis and management of dysfunctional hemodialysis access. Point-of-care ultrasounds are also being used by nephrologists to help manage volume status, especially in patients admitted to the intensive care units, and more recently, for guiding fluid removal in the outpatient dialysis units. Fundamental knowledge of sonography has become invaluable to the nephrologist, and performance and interpretation of ultrasound has now become an essential tool for practicing nephrologists to provide patient-centered care, maximize efficiency, and minimize fragmentation of care. This review will address the growing role of ultrasonography in the management of a patient with CKD from the point of initial contact with the nephrologist throughout the spectrum of kidney disease and its consequences.
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Koratala A, Bhattacharya D, Kazory A. Point of care renal ultrasonography for the busy nephrologist: A pictorial review. World J Nephrol 2019; 8:44-58. [PMID: 31363461 PMCID: PMC6656660 DOI: 10.5527/wjn.v8.i3.44] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Revised: 02/22/2019] [Accepted: 03/12/2019] [Indexed: 02/06/2023] Open
Abstract
The application of bedside ultrasonography in routine clinical practice has dramatically evolved over the last few decades and will likely continue to grow as technological advances lead to enhanced portability and affordability of the equipment. Despite mounting interest, most nephrology fellowship training programs do not offer formal training in renal ultrasonography and there is inertia among practicing nephrologists to adopt this skill as a practice-changing advancement. Lack of familiarity with the topic is considered a key reason for this inertia. Understanding of basic ultrasound physics, instrumentation, principles of optimal image acquisition and interpretation is critical for enhanced efficiency and patient safety while using this tool. Herein, we provide a brief overview of the basic principles of diagnostic renal ultrasonography as well as introduction to common sonographic pathologies encountered in day-to-day nephrology practice with illustrative images.
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Affiliation(s)
- Abhilash Koratala
- Division of Nephrology, Hypertension and Renal Transplantation, University of Florida, Gainesville, FL 32610-0224, United States
| | - Deepti Bhattacharya
- Division of Nephrology, Hypertension and Renal Transplantation, University of Florida, Gainesville, FL 32610-0224, United States
| | - Amir Kazory
- Division of Nephrology, Hypertension and Renal Transplantation, University of Florida, Gainesville, FL 32610-0224, United States
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Koratala A, Bhattacharya D, Kazory A. Point of care renal ultrasonography for the busy nephrologist: A pictorial review. World J Nephrol 2019. [DOI: 10.5527/wjcc.v8.i3.44] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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Point-of-care ultrasound in end-stage kidney disease: beyond lung ultrasound. Curr Opin Nephrol Hypertens 2019; 27:487-496. [PMID: 30188387 DOI: 10.1097/mnh.0000000000000453] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
PURPOSE OF REVIEW Following the miniaturization of ultrasound devices, point-of-care ultrasound (POCUS) has been proposed as a tool to enhance the value of physical examination in various clinical settings. The objective of this review is to describe the potential applications of POCUS in end-stage renal disease patients (ESRD). RECENT FINDINGS With basic training, the clinician can perform pulmonary, vascular, cardiac, and abdominal POCUS at the bedside of ESRD patients. Pulmonary ultrasound can be used to quantify pulmonary congestion and for the differential diagnosis of dyspnea. Ultrasound of the inferior vena cava combined with simple cardiac ultrasound can be used to promptly investigate the mechanism of hemodynamic instability. Vascular ultrasound can be used for troubleshooting of arteriovenous fistula problems and for catheter installation. Multiple potential applications of POCUS in the ESRD population are reviewed, including areas of future research. SUMMARY Acquiring basic skills in POCUS may improve patient care through the rapid identification of threats, improved diagnostic abilities for common symptoms, and safer procedures. The adoption of POCUS in undergraduate, internal medicine and nephrology training curriculums will likely lead to a gradual introduction of this technology in the care of ESRD patients.
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Liang XK, Li LJ, Wang XH, Wang XX, Wang YD, Xu ZF. Role of Lung Ultrasound in Adjusting Ultrafiltration Volume in Hemodialysis Patients. ULTRASOUND IN MEDICINE & BIOLOGY 2019; 45:732-740. [PMID: 30558830 DOI: 10.1016/j.ultrasmedbio.2018.10.025] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Revised: 10/16/2018] [Accepted: 10/22/2018] [Indexed: 06/09/2023]
Abstract
Chronic fluid over-hydration is common in dialysis patients. It is associated with mortality and cardiovascular events. Optimal methods for adjusting fluid volume status and ideal dry weight remain uncertain. The purpose of this study was to evaluate the usefulness of ultrasound in quantifying body water. In 35 hemodialysis patients, we performed ultrasound of the chest, pre-tibial skin tissue thickness (TT), heart and inferior vena cava (IVC) before and after dialysis. We compared B-line scores of lungs, IVC diameters and cardiac functions in pre-dialysis and post-dialysis groups. We then estimated the correlations between ultrasound parameters and ultrafiltration volumes. Ultrafiltration parameters were adjusted prospectively for subsequent dialysis. As a result, both extravascular and intravascular water decreased during ultrafiltration. The median numbers of B-line scores (10 [0-42] vs. 4 [0-30]; p < 0.001); mitral valve blood flow velocities E (0.83 ± 0.23 m/s vs. 0.70 ± 0.20 m/s; p < 0.001), A (0.93 ± 0.28 vs. 0.89 ± 0.23 m/s; p < 0.001) and E/e' (12.47 ± 4.92 vs. 10.37 ± 4.0; p < 0.001); IVC diameters at end-expiration (17.51 ± 3.33 mm vs. 14.26 ± 3.45 mm; p < 0.001); and right pre-tibial TT (2.86 ± 1.36 mm vs. 2.43 ± 1.24 mm; p < 0.001) decreased during dialysis. Ultrafiltration volume was most associated with B-line score (adjusting for age and sex) (β = -3.340; p = 0.003). In addition, the B-line score after dialysis was significantly associated with left ventricular ejection fraction (r = -0.393; p = 0.019) and TT (r = -0.447; p = 0.007). Ultrafiltration volume was prospectively increased then if the B-line score was >6 in the previous dialysis. All patients tolerated the protocol well without any symptoms. Ultrafiltration volume was most associated with lung water, reflected by variation in B-line score. It was not associated with cardiac function, IVC diameter, IVC collapse rate or TT. Lung ultrasound is a useful imaging tool for dialysis patients.
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Affiliation(s)
- Xuan-Kun Liang
- Department of Medical Ultrasonics, Seventh Affiliated Hospital of Sun Yat-Sen University, Shenzhen, Guangdong, China; Department of Medical Ultrasonics, Hexian Memorial Affiliated Hospital of Southern Medical University, Guangzhou, Guangdong, China
| | - Lu-Jing Li
- Department of Medical Ultrasonics, Seventh Affiliated Hospital of Sun Yat-Sen University, Shenzhen, Guangdong, China
| | - Xiao-Hua Wang
- Department of Nephrology, Seventh Affiliated Hospital of Sun Yat-Sen University, Shenzhen, Guangdong, China
| | - Xian-Xiang Wang
- Department of Medical Ultrasonics, Seventh Affiliated Hospital of Sun Yat-Sen University, Shenzhen, Guangdong, China
| | - Yang-Di Wang
- Department of Medical Ultrasonics, First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Zuo-Feng Xu
- Department of Medical Ultrasonics, Seventh Affiliated Hospital of Sun Yat-Sen University, Shenzhen, Guangdong, China.
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