Optimising flow without congestion using the venous-arterial Doppler enhanced resuscitation framework.

Area of Science:

• Critical care medicine
• Medical imaging
• Hemodynamics

Background:

• Intravenous (IV) fluid therapy is crucial in acute care, with ultrasound guiding fluid management for organ perfusion.
• Emerging evidence links excessive IV fluids to adverse outcomes, highlighting the need to monitor organ congestion.
• Current ultrasound methods for assessing arterial (perfusion) and venous (congestion) Doppler are often performed separately, increasing assessment time.

Observation:

• A case study utilized a wireless, wearable ultrasound device for simultaneous measurement of venous and arterial Doppler.
• This novel approach aimed to optimize fluid flow while preventing venous congestion.

Findings:

• Prior to IV volume expansion, Doppler measures indicated low central venous pressure (CVP) and stroke volume (SV).
• After IV fluid administration, venous Doppler remained stable, but carotid corrected flow time (ccFT) significantly increased, indicating improved arterial flow without congestion.

Implications:

• The development of a Venous-Arterial Doppler Enhanced Resuscitation (VADER) framework is proposed.
• VADER can guide IV fluid administration in patients susceptible to venous congestion.
• This integrated approach offers a more efficient and comprehensive method for fluid management in critical care settings.