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Demystifying Volume Status: An Ultrasound-Guided Physiologic Framework.

Juliana Yl Kan1, Shane Arishenkoff2, Katie Wiskar2

  • 1Department of Internal Medicine, Singapore General Hospital, Singapore, Republic of Singapore.

Chest
|January 9, 2025
PubMed
Summary

Point-of-care ultrasound (POCUS) aids in assessing patient volume status, a critical yet challenging clinical task. Integrating POCUS findings with traditional methods improves fluid management decisions.

Keywords:
fluid statushemodynamicsphysiologypoint-of-care ultrasoundvolume status

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Area of Science:

  • Critical Care Medicine
  • Cardiovascular Physiology
  • Point-of-Care Diagnostics

Background:

  • Accurate volume status assessment is vital for managing diverse clinical conditions, guiding fluid therapy, vasoactive agent use, and decongestive treatments.
  • Challenges in determining volume status arise from physical examination limitations, diagnostic uncertainties, and complex fluid homeostasis in disease.
  • Point-of-care ultrasound (POCUS) offers a valuable tool for evaluating hemodynamic parameters linked to volume status, fluid responsiveness, and tolerance.

Purpose of the Study:

  • To review foundational physiologic concepts for volume status evaluation.
  • To highlight the utility of multiorgan POCUS in assessing hemodynamic and structural parameters.
  • To demonstrate the integration of POCUS findings with conventional clinical assessment for fluid management.

Main Methods:

  • Review of physiologic concepts underpinning volume status assessment.
  • Discussion of POCUS applications for evaluating central venous pressure, cardiac function, and extravascular volume.
  • Illustration of POCUS integration in clinical scenarios like hypotension, hypoxia, and acute kidney injury.

Main Results:

  • POCUS provides access to hemodynamic and structural data, extending the physical examination for volume status assessment.
  • A comprehensive assessment framework includes central venous pressure, right and left heart function, extravascular volume, and venous congestion.
  • Integration of multiple POCUS findings with clinical data is essential for accurate interpretation.

Conclusions:

  • Volume status assessment is essential but difficult, requiring a synthesis of physiologic understanding and diagnostic tools.
  • Multiorgan POCUS elucidates key hemodynamic parameters, enhancing conventional clinical assessments for fluid-related decision-making.
  • Further research is needed to establish the clinical benefits and outcomes of POCUS-guided volume status assessment.