ABSTRACT
Resumen: Introducción: La ultrasonografía es una herramienta indispensable en el diagnóstico y seguimiento de los enfermos en estado crítico durante las últimas tres décadas. En la actualidad, el diagnóstico de choque hipovolémico se realiza a través de la monitorización de signos vitales, la identificación y cuantificación de pérdidas sanguíneas y marcadores de hipoperfusión tisular. Sin embargo, se ha demostrado de manera amplia que la hipotensión y taquicardia no son específicas ni sensibles para realizar dicho diagnóstico al mismo tiempo que se alteran en estadios avanzados del estado de choque, por lo que resultan ineficaces en la identificación temprana y toma de decisiones, los marcadores de hipoperfusión tisular son costosos y no siempre se cuenta con los insumos necesarios. Metodología: Se llevó a cabo la medición de la colapsabilidad de la vena cava inferior en pacientes sanos previo y posterior a la donación de 450 cm3 en el Banco de Sangre Estatal de Ecatepec durante el periodo comprendido de marzo a agosto de 2017. Se realizó en personas de entre 16 y 65 años de edad que se encontraban sanos, que aceptaron participar en el estudio previa firma de carta de consentimiento informado y en los que técnicamente fue realizable la medición de las variables con el ultrasonido, tomando como universo la medición realizada en 87 sujetos, de los cuales 75% fueron hombres y 25% fueron mujeres, se realizó medición de la colapsabilidad de la vena cava inferior antes y después de realizar la exanguinación de 450 cm3, se calculó el volumen sanguíneo circulante y sangrado permisible, se calculó el porcentaje de sangrado permisible al que equivalen 450 cm3 en cada individuo y se homologó la pérdida sanguínea con el porcentaje de pérdida hemática propuesta por el Colegio de Cirujanos para la clasificación de choque hemorrágico. Conclusión: Con el universo de casos revisados se plantea agregar la medición de la colapsabilidad de la vena cava inferior como una evaluación complementaria, accesible y barata en la complementación del diagnóstico y seguimiento del choque hipovolémico en los pacientes de la UCI y Urgencias.
Abstract: Introduction: Ultrasonography is an indispensable tool in the diagnosis and monitoring of critically ill patients during the last three decades. Currently the diagnosis of hypovolemic shock is made through the monitoring of vital signs, the identification and quantification of blood loss and markers of tissue hypoperfusion. However, it has been amply demonstrated that hypotension and tachycardia are not specific or sensitive to perform such a diagnosis at the same time that they are altered in advanced stages of the shock state, so they are ineffective in the early identification and decision making. of tissue hypoperfusion are expensive and the necessary supplies are not always available. Methodology: The collapse of the inferior vena cava was measured in healthy patients before and after the 450 cm3 donation in the state blood bank of Ecatepec during the period from March to August 2017. It was performed in patients between 16 and 65 years of age, who were healthy, who agreed to participate in the study after signing an informed consent letter and in which it was technically feasible to measure the variables with ultrasound, taking as a universe the measurement performed in 87 patients of which 75% were male and 25% were female, inferior vena cava collapsibility was measured before and after performing the 450 cm3 exsanguination, the circulating blood volume and permissible bleeding were calculated, it was calculated the percentage of permissible bleeding equivalent to 450 cm3 in each patient and the blood loss was homologous with the percentage of blood loss proposed by the college of surgeons for the classification of hemorrhagic shock. Conclusion: With the universe of patients reviewed, it is proposed to add the measurement of inferior vena cava collapsibility as a complementary, accessible and inexpensive evaluation in the complementation of the diagnosis and monitoring of hypovolemic shock in ICU and emergency patients.
Resumo: Introdução: A ultrassonografia é uma ferramenta indispensável no diagnóstico e monitoramento de pacientes críticos durante as últimas três décadas. Atualmente, o diagnóstico de choque hipovolêmico é feito através do monitoramento de sinais vitais, identificação e quantificação de perdas de sangue e marcadores de hipoperfusão tecidual. No entanto, tem sido amplamente demonstrado que a hipotensão e a taquicardia não são específicas ou sensíveis para fazer esse diagnóstico ao mesmo tempo em que são alteradas nos estágios avançados do estado de choque e, portanto, são ineficazes na identificação e tomada de decisões precoces. Os marcadores de hipoperfusão de tecido são caros e os suprimentos necessários nem sempre estão disponíveis. Metodologia: A medida do colapso da veia cava inferior foi realizada em pacientes saudáveis antes e após a doação de 450 cm3 no banco de sangue do estado de Ecatepec no período de março a agosto de 2017. Foi realizada em pacientes entre 16 e 65 anos, saudáveis, que concordaram em participar do estudo anterior assinando um termo de consentimento livre e esclarecido e no qual a mensuração das variáveis com o ultrassom era tecnicamente viável, tomando como universo a mensuração realizada em 87 pacientes, dos quais 75% eram do sexo masculino e 25% do feminino, uma medida do colapso da veia cava inferior foi realizada antes e após a exsanguinação de 450 cm3, foram calculados o volume sanguíneo circulante e o sangramento permitido, a porcentagem de sangramento admissível na qual equivalente a 450 cm3 em cada paciente e a perda de sangue foi aprovada com o percentual de perda de sangue proposto pela faculdade de cirurgia para a classificação do choque hemorrágico. Conclusão: Com a revisão do universo de pacientes, a mensuração do colapso da veia cava inferior é considerada uma avaliação complementar, acessível e barata na complementação do diagnóstico e monitoramento do choque hipovolêmico em UTI e pacientes de emergência.
ABSTRACT
Background: Ultrasound guided fluid assessment in management of septic shock has come up as an adjunct to the current gold standard Central Venous Pressure monitoring. This study was designed to observe the respiro-phasic variation of IVC diameter (RV-IVCD) in invasively mechanically ventilated and spontaneously breathing paediatric patients of fluid refractory septic shock.Methods: This was a prospective observational study done at Paediatric intensive Care Unit (PICU) in Paediatric ward of Jawaharlal Nehru Medical College and Hospital (JNMCH) from February 2016 to June 2017. 107 consecutive patients between 1 year to 16 years age who were in shock despite 40ml/kg of fluid administration were included. Inferior Vena Cava (IVC) diameters were measured at end-expiration and end inspiration and the IVC collapsibility index was calculated. Simultaneously Central Venous Pressure (CVP) was recorded. Both values were obtained in ventilated and non-ventilated patients. Data was analysed to determine to look for the profile of RV-IVCD and CVP in ventilated and non-ventilated cases.Results: Out of 107 patients, 91 were on invasive mechanical ventilation and 16 patients were spontaneously breathing. There was a strong negative correlation between central venous pressure (CVP) and inferior vena cava collapsibility (RV-IVCD) in both spontaneously breathing (-0.810) and mechanically ventilated patients (-0.700). Negative correlation was significant in both study groups in CVP <8 mmHg and only in spontaneously breathing patients in CVP 8-12 mmHg range. IVC collapsibility showed a decreasing trend with rising CVP in both spontaneously breathing and mechanically ventilated patients.Conclusion: Ultrasonography guided IVCCI appears to be a valuable index in assessing fluid status in both spontaneously breathing and mechanically ventilated septic shock patients. However, more data is required from the paediatric population so as to define it as standard of practice.
ABSTRACT
Background: There is triad of hypoalbuminemia, edema, and hyperlipidemia in nephrotic syndrome patients. Management of nephrotic syndrome includes general measures like fluid restriction, emergency albumin transfusions and diuretics that provide symptomatic relief till steroids act. These measures require an assessment of body fluid volume to avoid circulatory failure which is very difficult in these patients because of edema. The objective of the study was to measure and compare the Inferior Vena Cava (IVC) Index and Inferior Vena Cava Collapsibility (IVCC) Index by ultrasound as a measure of body fluid volume status in children with nephrotic syndrome.Methods: The present observational study was conducted in all children of age more than 1 year up to 18 year. There were two groups; group 1 was nephrotic syndrome patients-Initial episode or in relapse and group 2 (Control) was age and sex-matched non-nephrotic children. IVC index and IVCC index were measured and compared in both the groups.Results: Mean value of minimum diameter of IVC during inspiration in cases was 5.91'1.60 mm as compared to 4.53'0.94 mm in controls which was significantly higher in case group {P ?0.0001}. Mean value of IVC index in cases was 0.88'0.20 cm/m2 as compared to 0.93'0.19 cm/m2 in controls which was non-significant. Mean value of IVCC index in cases (35.61'13.68) was significantly less as compared to controls (52.23'2.01) {P ?0.0001}.Conclusions: The present study concluded that IVCC index is better indicator of body fluid volume status in nephrotic patients as compare to IVC index.