CẬP NHẬT VAI TRÒ CỦA POCUS TRONG QUẢN LÍ BỆNH NHÂN NHIỄM KHUẨN HUYẾT: PERFUSION AND CONGESTION

BSCKI. NGUYỄN XUÂN BÁCH

KHOA HSCC- BVCR

Evolution of Fluid responsiveness

• The prediction of fluid responsiveness

Monnet, X., Malbrain, M.L.N.G. & Pinsky, M.R. The prediction of fluid responsiveness.Intensive Care Med 49, 83–86 (2023)

Misconcept in Fluid responsiveness

• Trigger of Fluid administration
• Fluid infusion until Fluid unresponsiveness
• Rarely venous congest concordant

Fluid Reponsiveness

Fluid Overload

Fluid intolerance

Muñoz, F., Born, P., Bruna, M. et al. Coexistence of a fluid responsive state and venous congestion signals in critically ill patients: a multicenter observational proof-of-concept study. Crit Care 28, 52 (2024).

Fluid responsive

• PPV
• SPV
• PLR
• EEOT

Fluid intolerance

• CVP > 12mmHg
• VeXUS score > 1
• LUS > 10
• E/e’ > 10

​

Venous back-pressure

Pearl and Pitfall

Koratala A, Reisinger N. Venous Excess Doppler Ultrasound for the Nephrologist: Pearls and Pitfalls. Kidney Med. 2022;4(7):100482.

Putting it together

4 phenotype:

1. Fluid responsiveness (+) and Fluid Tolerance (+)
2. Fluid responsiveness (+) and Fluid Tolerance (-)
3. Fluid responsiveness ( -) and Fluid tolerance (+)
4. Fluid responsiveness (-) and Fluid tolerance (-)

​

Should we priority fluid tolerance?

Kết luận

• Sung huyết tĩnh mạch đóng vai trò quan trọng không chỉ trong giai đoạn hồi sức
• Các chỉ số VEXUS, siêu âm phổi, áp lực nhĩ trái tương quan tốt với tình trạng sung huyết