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Accurate assessment of hemodynamic status is crucial for volume management. Venous congestion caused by volume overload can cause organ damage and poor prognosis. Traditional critical ultrasound, including inferior vena cava ultrasound, echocardiography, and lung ultrasound, is widely used in volume management. However, it is unable to evaluate the organ blood flow. The blood flow pattern of abdominal vein changes dynamically with venous congestion, which is an index for evaluating the blood flow of hepatic vein, portal vein and internal renal vein by Doppler ultrasound. This article reviews the acquisition and grading standards of abdominal venous blood flow patterns, their application and limitations in volume management, with a view to providing help for early clinical identification of terminal organ congestion, implementation of fluid negative balance intervention and individualized volume management.
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Objective:To investigate the volume management of intermittent veno-venous hemofiltration (IVVH) guided by critical care ultrasound in the treatment of acute kidney injury (AKI) in patients with heart failure (HF).Methods:A total of 216 patients with HF and AKI treated with IVVH in the coronary care unit (CCU) of the Third Central Hospital of Tianjin from April 2019 to June 2022 were selected as the study subjects, the patients were randomly divided into conventional guidance group (107 cases) and ultrasound guidance group (109 cases). According to the recovery of renal function, IVVH was performed 12 hours every day or 12 hours every other day. The conventional guidance group selected the conventional method to formulate IVVH prescription, and the ultrasound guidance group used critical care ultrasound to adjust the treatment parameters of IVVH on the basis of the conventional guidance group. Respiratory variation index (RVI) of inferior vena cava (IVC), right left ventricular end-diastolic transverse area ratio, early diastolic peak mitral flow velocity/mitral annulus velocity peak (E/E'), aortic flow velocity time integral (VTI), cardiac output (CO), bilateral lung ultrasound B-line range, bilateral renal interlobar arteries resistance index (RI) were recorded before and 3, 6, 9 hours after each treatment. The net dehydration rate was adjusted in real time according to the comprehensive results. Urine volume, serum creatinine (SCr), estimated glomerular filtration rate (eGFR), blood B-type brain natriuretic peptide (BNP), β 2-microglobulin (β 2-MG) and cystatin C (Cys C) levels of patients in both groups were monitored before and 3, 7 and 10 days after initial treatment, and renal function recovery and clinical prognostic indexes of patients in both groups were recorded. Results:The dehydration rate of the ultrasound guidance group was slow at the beginning of IVVH, and gradually increased after 6 hours, and the overall dehydration rate was significantly slower than that of the conventional guidance group. In the ultrasound guidance group using critical care ultrasound, the RVI gradually increased, the right left ventricular end-diastolic area ratio gradually decreased, the E/E' ratio gradually decreased, and the range of B-line of bilateral lungs gradually decreased, RI of bilateral renal interlobar arteries decreased. At 3, 7 and 10 days after the first IVVH, renal function related indexes in both groups were significantly improved compared with before treatment, and the decline rate of β 2-MG and Cys C in the ultrasound guidance group was faster than that in the conventional guidance group at early (3 days) [β 2-MG (mg/L): 3.69±1.31 vs. 3.99±1.45, Cys C (mg/L): 2.91±0.95 vs. 3.14±0.96, both P < 0.05], urine volume, SCr and eGFR at 7 days were also significantly improved compared with the conventional guidance group [24-hour urine volume (mL): 1 128.23±153.92 vs. 1 015.01±114.18, SCr (μmol/L): 145.86±32.25 vs. 155.64±28.42, eGFR (mL/min): 50.26±11.24 vs. 46.51±10.61, all P < 0.05]. The time of SCr recovery, the time of reaching polyuria, the total time of IVVH treatment, the time of non-invasive mechanical ventilation and the time of living in CCU in the ultrasound guidance group were shorter than those in the conventional guidance group. The incidences of hypotension, long-term RRT, incidence of major cardiovascular adverse event (MACE) and at 28-day mortality were all lower than those in the conventional guidance group. Kaplan-Meier survival curve showed that the 28-day cumulative survival rate in the ultrasound guidance group was significantly lower than that in the conventional guidance group (Log-Rank test: χ 2 = 3.903, P = 0.048). Conclusion:The strategy of IVVH guided by critical care ultrasound in the treatment of HF with AKI has unique advantages.
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Objective:To understand the knowledge, attitude and behavior of volume management of maintenance hemodialysis patients, so as to provide a basis for standardizing volume management and carrying out refined individual care.Methods:By means of convenience sampling, 608 patients from 4 hospitals who received regular dialysis treatment in Xuzhou and Yancheng hemodialysis rooms in October 2021 were selected as subjects. Patients were surveyed by a self-designed knowledge questionnaires of volume management, Maintenance Hemodialysis Patients′ Capacity Management Behavior Scale and Self-Efficacy Scale. Questionnaires were collected through the questionnaire star.Results:A total of 608 valid questionnaires were collected. The knowledge dimension scored 8.21 ± 2.27 , atitude dimension scored 7.36 ± 2.06 and behavior dimension scored 15.07 ± 4.22. Multiplelinear regression analysis showed that age, dialysis age and self-care ability were predictors of volume management knowledge score ( t=-2.07, 2.35, -3.90, all P<0.05 ). Medical insurance type was a predictor of volume management attitude score ( t=-2.17, P<0.05). Education level was a predictor of volume management behavior score ( t=3.04, P<0.05). Conclusions:The capacity management knowledge and capacity management attitude of maintenance hemodialysis patients is in the medium level, but with poor volume management executive ability. It is suggested that medical staff carry out health education related to volume management according to different characteristics of patients, and effectively improve patients′ volume management ability.
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Objective:To explore the status of volume management behavior in patients with peritoneal dialysis, and to explore the relationship between health belief and volume management behavior.Methods:Convenient sampling was used to select 129 patients who underwent regular dialysis in the peritoneal dialysis center of the General Hospital of Ningxia Medical University from January to December 2019. The general condition questionnaire, Health Belief Scale, and Capacity Management Behavior Scale for patients with peritoneal dialysis were used.Results:The total score of the Capacity Management Behavior Scale of peritoneal dialysis patients was 20.23±3.54. Among all the entries: "Weigh and record the infusion volume and drainage volume" and "Regular monitoring of renal function and electrolytes and other related examinations as directed by the doctor" scored higher; while the item "Eat less high-salt and high-sodium food and adjust fluid intake according to the amount of ultrafiltration, edema and urine output" item scored lower; single factor analysis found that different educational levels, different employment conditions, whether had diabetes mellius and different over hydration had statistical significance ( F value was 3.911, t values were 2.409, 4.990, 6.070, P<0.05). The dimension of the perception maintenance capacity balance disorder was negatively correlated with the total score and each dimension of the capacity management behavior( r values were -0.243, -0.260, -0.299, P<0.05) , and the liquid intake self-efficacy dimension is positively correlated with the total score and each dimension of the capacity management behavior ( r values were 0.329, 0.397, 0.393, P<0.05). Conclusions:The level of capacity management behavior of peritoneal dialysis patients needs to be improved; employment status, and whether he has diabetes or not are the influencing factors of the patients' capacity management behavior; in health beliefs, perception of maintenance of volume balance disorders and self-efficacy and peritoneal dialysis are correlated with patients' capacity management behaviors.
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Objective:To analyze the early volume characteristics of patients with severe cardiogenic shock treated with veno-arterial extracorporeal membrane oxygenation (VA-ECMO) and the relationship between their early volume and the prognosis.Methods:This study reviewed patients of Emergency Medical University , treated with VA-ECMO and screened the patients with severe cardiogenic shock and VA-ECMO running more than 72 h for further study. The basic condition of the patients was recorded, and the fluid balance in the first 72 h was analyzed. The patients were grouped according to their fluid balance in the first 72 h. The gender, age, survival rate, continuous renal replacement therapy (CRRT) rate, intra-aortic balloon pump (IABP) rate, and invasive mechanical ventilation rate were compared between the two groups, and the relative risk to the prognosis was calculated. The prognosis was compared between the two groups. Results:Totally 77 patients with severe cardiogenic shock were enrolled. Forty-one cases survived, with an overall survival rate of 53.2%. The volume balance at 48-72 h and the total volume balance at the first 72 h were different between the survival and dead groups. Compared with the positive balance group, patients in the negative balance group were less likely to receive CRRT or invasive mechanical ventilation during the first 72 h. Patients in the negative balance group during the first 72 h had a better survival rate, and their relative risk of survival was 1.81 (95% confidence interval: 1.101, 2.985). However, there was no significant difference in survival rate according to every 24 h fluid balance.Conclusions:Patients with severe cardiogenic shock treated with VA-ECMO who had negative total volume balance during the first 72 h are more likely to survive and less likely to require CRRT or invasive mechanical ventilation.
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The effective fluid resuscitation and management can not only save time for subsequent treatment measures but also lay the foundation for correcting blood loss and coagulation dysfunction,which helps avoid organ damage due to volume disorder during the treatment of amniotic fluid embolism(AFE).Amniotic fluid embolism management includes three parts:the phase of controlling volume load in right heart failure to avoid aggravation of pulmonary edema,maintain hemodynamic stability,the fluid resuscitationin cycle support phasea and restrictive fluid resuscitation in DIC phase.
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Objective To investigate whether mixed venous-arterial carbon dioxide difference (Pv-aCO2) combined with passive leg raising (PLR) could better guide volume management for patients post off-pump coronary artery bypass grafting (OPCABG).Methods Eighty patients experienced OPCABG, and admitted to Tianjin Chest Hospital from June 1st to October 1st in 2016 were enrolled. They were randomly divided into two groups: observation group given Pv-aCO2 combined with PLR directed therapy and control group given central venous pressure (CVP) directed therapy, 40 cases in each group. The difference in body temperature (T), heart rate (HR), mean arterial pressure (MAP), CVP, oxygenation index (PaO2/FiO2), mixed venous oxygen saturation (SvO2), Pv-aCO2, blood lactate (Lac), fluid intake, scores of the vasoactive agents at 6 hours post-operation, sequential organ failure assessment (SOFA) of 24 hours, mechanical ventilation time, the length of intensive care unit (ICU) stay, and hospitalization time were compared. The correlation between Pv-aCO2 and cardiac index (CI), Pv-aCO2 and Lac were analyzed by Spearman analysis in observation group.Results The T, HR, MAP, CVP, PaO2/FiO2, SvO2 and Lac at 6 hours post-operation were higher than those at admission in two groups, and Pv-aCO2 were significantly decreased. The SvO2 and fluid intake in observation group were higher than those in control group [SvO2: 0.671±0.068 vs. 0.634±0.052, fluid intake (mL): 454±151 vs. 304±106, bothP < 0.05], Pv-aCO2, Lac and scores of the vasoactive agents were lower than those in control group [Pv-aCO2 (mmHg, 1 mmHg = 0.133 kPa): 6.1±1.8 vs. 7.0±1.8, Lac (mmol/L): 1.7±0.5 vs. 2.8±0.6, scores of the vasoactive agents: 3.18±1.01 vs. 4.48±1.50, allP < 0.05], mechanical ventilation time and the length of ICU stay were less than those in the control group (hours: 16.52±6.41 vs. 21.96±9.00, 45.51±9.36 vs. 51.76±13.66, bothP< 0.05). There was no significant difference in SOFA, hospitalization time between the two groups. There was negative correlation with Pv-aCO2 and CI (r = -0.752,P < 0.01), and no correlation with Pv-aCO2 and Lac (r = -0.154,P = 0.171).Conclusion Pv-aCO2 combined with PLR can better guide volume management in the patients post OPCABG, reduce the usage of vasoactive agents and decrease the mechanical ventilation time and the length of ICU stay.
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Objective To evaluate the efficacy of left ventricular ejection time (LVET) in guiding the volume management during liver transplantation.Methods Sixty American Society of Anesthesiologists physical status Ⅱ or Ⅲ patients,aged 32-64 yr,weighing 54-93 kg,of Child-Pugh grade A or B liver function,scheduled for elective the first liver transplantation with general anesthesia,were divided into either control group (group C) or transesophageal echocardiography (TEE) monitoring group (group TEE),with 30 patients in each group.In group C,the fluctuating range of mean arterial pressure,heart rate and central venous pressure was maintained less than 20％ of the baseline value,and the urine volume was maintained ＞1 ml · kg-1 · h-1.LVET was maintained between 0.35-0.40 s in group TEE.The consumption of intraoperative vasoactive agents (dopamine,norepinephrine,epinephrine),volume of fluid infused,volume of blood transfused,blood loss and urine volume were recorded.The occurrence of adverse events was observed during the perioperative period,and postoperative extubation time and intensive care unit residence time were also recorded.Results Compared with group C,the consumption of intraoperative dopamine and norepinephrine was significantly decreased,the urine volume was increased,the incidence of myocardial ischemia,pulmonary edema and renal failure in the perioperative period was decreased,and the postoperative extubation time and intensive care unit residence time were shortened in group TEE (P＜0.05).There was no significant difference between the two groups in the volume of crystalloid,colloid,red blood cells and plasma infused or blood loss (P＞0.05).Conclusion LVET produces good efficacy in guiding the volume management during liver transplantation.
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Objective To evaluate the effectiveness of bioelectrical impedance analysis(BIA) interventions on volume status in hemodialysis patient. Methods Searched The Cochrane Library, PubMed, EMbase, EBsco, Wanfang Data, China Biology Medicine, China National Knowledge Infrastructure to collect clinical trials. The retrieval time was from database to July 15, 2016. The studies were selected according to the inclusion and exclusion criteria and were critically appraised by two reviewers. Then the data of included studies were extracted. Meta-analysis was conducted by using RevMan 5.3 software and descriptive analysis. Results Ten clinical trials were included six random control trial, one controlled clinical trail, three longitudinal study, involving 2009 patients. The results of Meta-analysis showed that the effectiveness of BIA interventions on volume management could improve blood pressure (P=0.001), protect the heart function(left ventricular mass index,P=0.002), compared with the clinical evaluation method, the BIA assessment of dry weight of hemodialysis patients could reduce hospitalization rate 14%. Descriptive analysis showed that BIA intervention volume management had certain advantages for the survival benefit of patients, but the current research was still few, had not yet come to a certain conclusion. Conclusions BIA can improve the management of the volume status and dry weight of hemodialysis patients, so as to it can improve the clinical benefit and survival benefit of patients.Better methods and guidelines for assessing DW and using BIA need to be developed.We propose that experienced HD nursing staff be trained in the use of the BIA to help monitor patient over hydration and approximate dry weight in consultation with the nephrologists responsible for the care of these patients so as to obviate excessive residual over hydration between nephrology reviews.
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Objective To explore the influencing factors of heart failure among patients with continuous ambulatory peritoneal dialysis(CAPD).Method Clinical data were collected from the histories of 158 patients receiving CAPD to investigate the factors inducing heart failure for the purpose of finding out the potential independent influencing factors using t test or chi-square test for univariate analyses and logistic regression in multivariate analyses.Results The incidence of heart failure was 36.71%among the enrolled CAPD patients.Single factor analysis showed that level of volume management,age,hemoglobin,serum pre-albumin, cholesterol and c-reactive protein were related to heart failure.Analysis of multiple variables logistic regression revealed that levels of volume management,serum pre-albumin and blood urea nitrogen were related to heart failure.Conclusions It is an easy,effective and cheaper way for nurses to increase patients’ability of volume control.The strategy including remedying malnutrition and decreasing the level of uremic toxins might be effective for delayed exacerbation of cardiac function among CAPD patients.
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Objective To develop the scale of volume-management for peritoneal dialysis(PD) patients.Methods The item pool was formulated based on literature review and in-depth interviews.An initial scale was constructed through two rounds of Delphi expert consultation and preliminary test.Totally 125 PD patients from Jiangsu-Zhejiang-Shanghai area were investigated to test the reliability and validity of the scale.Results 2 factors were extracted by exploratory factor analysis,which contained 8 items and could explain 66.07％ of the total variance.The content validity index was 1.0,the Cronbach α was 0.870,and test-retest reliability was 0.930.Conclusions The scale is proved to be a reliable and valid tool for the volume-management assessment of PD patients.
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Objective To evaluate the effect of volume management on volume overload among continuous ambulatory peritoneal dialysis (CAPD).Methods The literature were searched by the databases of PubMed,ScienceDirect,Ovid,Cochrane Library,Chinese Science and Technology Periodical Databases (VIP),China National Knowledge Infrastructure (CNKI).Data were analyzed with RevMan5.0 software.Results Ten literatures were included in this study.The results of Meta-analysis revealed that volume management could significantly reduce the body weight,degree of edema and systolic blood pressure.However,no significant difference on the diastolic blood pressure appeared.Conclusions Body weight,degree of edema and systolic blood pressure can be improved by effective volume management.Further study about effect of volume control on diastolic blood pressure should be provided in the future.