Pourmand Ali, Pyle Matthew, Yamane David, Sumon Kazi, Frasure Sarah E
Department of Emergency Medicine, George Washington University School of Medicine and Health Sciences, Washington, DC, USA.
World J Emerg Med. 2019;10(4):232-238. doi: 10.5847/wjem.j.1920-8642.2019.04.007.
Volume resuscitation has only been demonstrated to be effective in approximately fifty percent of patients. The remaining patients do not respond to volume resuscitation and may even develop adverse outcomes (such as acute pulmonary edema necessitating endotracheal intubation). We believe that point-of-care ultrasound is an excellent modality by which to adequately predict which patients may benefit from volume resuscitation.
We performed a search using PubMed, Scopus, and MEDLINE. The following search terms were used: fluid responsiveness, ultrasound, non-invasive, hemodynamic, fluid challenge, and passive leg raise. Preference was given to clinical trials and review articles that were most relevant to the topic of assessing a patient's cardiovascular ability to respond to intravenous fluid administration using ultrasound.
Point-of-care ultrasound can be easily employed to measure the diameter and collapsibility of various large vessels including the inferior vena cava, common carotid artery, subclavian vein, internal jugular vein, and femoral vein. Such parameters are closely related to dynamic measures of fluid responsiveness and can be used by providers to help guide fluid resuscitation in critically ill patients.
Ultrasound in combination with passive leg raise is a non-invasive, cost- and time-effective modality that can be employed to assess volume status and response to fluid resuscitation. Traditionally sonographic studies have focused on the evaluation of large veins such as the inferior vena cava, and internal jugular vein. A number of recently published studies also demonstrate the usefulness of evaluating large arteries to predict volume status.
仅约50%的患者经容量复苏后显示有效。其余患者对容量复苏无反应，甚至可能出现不良后果（如因急性肺水肿需行气管插管）。我们认为，床旁超声是一种很好的方法，可充分预测哪些患者可能从容量复苏中获益。
我们使用PubMed、Scopus和MEDLINE进行了检索。使用了以下检索词：液体反应性、超声、非侵入性、血流动力学、液体负荷试验和被动抬腿试验。优先选择与使用超声评估患者心血管对静脉输液反应能力这一主题最相关的临床试验和综述文章。
床旁超声可轻松用于测量包括下腔静脉、颈总动脉、锁骨下静脉、颈内静脉和股静脉在内的各种大血管的直径和可压缩性。这些参数与液体反应性的动态测量密切相关，可供医疗人员用于指导重症患者的液体复苏。
超声结合被动抬腿试验是一种非侵入性、经济且省时的方法，可用于评估容量状态和对液体复苏的反应。传统的超声研究主要集中在下腔静脉和颈内静脉等大静脉的评估。最近发表的一些研究也证明了评估大动脉对预测容量状态的有用性。
