Skip to main content
Hauptrubriken
CME Facharzt-Training Webinare Zeitschriften Bücher e.Medpedia Podcast
Service
Jobbörse Info & Hilfe
Fachgebiete
Anästhesiologie Allgemeinmedizin Arbeitsmedizin Augenheilkunde Chirurgie Dermatologie Gynäkologie und Geburtshilfe HNO Innere Medizin Kardiologie Neurologie Onkologie und Hämatologie Orthopädie und Unfallchirurgie Pädiatrie Pathologie Psychiatrie Radiologie Rechtsmedizin Urologie Zahnmedizin
Themen
Klimawandel und Gesundheit Neues aus dem Markt COVID-19 Praxis und Beruf Seltene Erkrankungen GOÄ & EBM Panorama
Sammlungen
Kasuistiken Algorithmen & Infografiken Blickdiagnosen Arthropedia FlapFinder (für Dermatochirurgen) Videos Kongressberichterstattung Medizin für Apothekerinnen und Apotheker Für Ärztinnen und Ärzte in Weiterbildung Für Medizinstudierende
Erweiterte Suche
Anmelden
nach oben
Medizinische Klinik - Intensivmedizin und Notfallmedizin
Erschienen in: Medizinische Klinik - Intensivmedizin und Notfallmedizin 4/2017

16.12.2015 | Übersichten

Assessment of volume status and fluid responsiveness in the emergency department: a systematic approach

verfasst von: C. Maurer, MD, J. Y. Wagner, MD, R. M. Schmid, MD, B. Saugel, MD

Erschienen in: Medizinische Klinik - Intensivmedizin und Notfallmedizin | Ausgabe 4/2017

Einloggen, um Zugang zu erhalten

Abstract

When treating acutely ill patients in the emergency department (ED), the successful management of a variety of medical conditions, such as sepsis, acute kidney injury, and pancreatitis, is highly dependent on the correct assessment and optimization of a patient’s intravascular volume status. Therefore, it is crucial that the ED physician knows and uses available means to assess intravascular volume status to adequately guide fluid therapy. This review focuses on techniques for volume status assessment that are available in the ED including basic clinical and laboratory findings, apparatus-based tests such as sonography and chest x-ray, and functional tests to evaluate fluid responsiveness. Furthermore, we provide an outlook on promising innovative, noninvasive technologies that might be used for advanced hemodynamic monitoring in the ED.
Literatur
1.
2.
Wu BU, Banks PA (2013) Clinical management of patients with acute pancreatitis. Gastroenterology 144:1272–1281CrossRefPubMed
3.
Nadeau-Fredette AC, Bouchard J (2013) Fluid management and use of diuretics in acute kidney injury. Adv Chronic Kidney Dis 20:45–55CrossRefPubMed
4.
5.
Vincent JL, De Backer D (2014) Circulatory shock. N Engl J Med 370:583PubMed
6.
7.
Gross CR, Lindquist RD, Woolley AC, Granieri R, Allard K, Webster B (1992) Clinical indicators of dehydration severity in elderly patients. J Emerg Med 10:267–274CrossRefPubMed
8.
Stephan F, Flahault A, Dieudonne N, Hollande J, Paillard F, Bonnet F (2001) Clinical evaluation of circulating blood volume in critically ill patients—contribution of a clinical scoring system. Br J Anaesth 86:754–762CrossRefPubMed
9.
Koziol-McLain J, Lowenstein SR, Fuller B (1991) Orthostatic vital signs in emergency department patients. Ann Emerg Med 20:606–610CrossRefPubMed
10.
McGee S, Abernethy WB III, Simel DL (1999) The rational clinical examination. Is this patient hypovolemic? JAMA 281:1022–1029CrossRefPubMed
11.
Wang CS, FitzGerald JM, Schulzer M, Mak E, Ayas NT (2005) Does this dyspneic patient in the emergency department have congestive heart failure? JAMA 294:1944–1956CrossRefPubMed
12.
Badgett RG, Lucey CR, Mulrow CD (1997) Can the clinical examination diagnose left-sided heart failure in adults? JAMA 277:1712–1719CrossRefPubMed
13.
Killip T III, Kimball JT (1967) Treatment of myocardial infarction in a coronary care unit. A two year experience with 250 patients. Am J Cardiol 20:457–464CrossRefPubMed
14.
Saugel B, Ringmaier S, Holzapfel K, Schuster T, Phillip V, Schmid RM et al (2011) Physical examination, central venous pressure, and chest radiography for the prediction of transpulmonary thermodilution-derived hemodynamic parameters in critically ill patients: a prospective trial. J Crit Care 26:402–410CrossRefPubMed
15.
Chung HM, Kluge R, Schrier RW, Anderson RJ (1987) Clinical assessment of extracellular fluid volume in hyponatremia. Am J Med 83:905–908CrossRefPubMed
16.
Dossetor JB (1966) Creatininemia versus uremia. The relative significance of blood urea nitrogen and serum creatinine concentrations in azotemia. Ann Intern Med 65:1287–1299CrossRefPubMed
17.
Schrier RW (2007) Decreased effective blood volume in edematous disorders: what does this mean? J Am Soc Nephrol 18:2028–2031CrossRefPubMed
18.
Swedko PJ, Clark HD, Paramsothy K, Akbari A (2003) Serum creatinine is an inadequate screening test for renal failure in elderly patients. Arch Intern Med 163:356–360CrossRefPubMed
19.
Carvounis CP, Nisar S, Guro-Razuman S (2002) Significance of the fractional excretion of urea in the differential diagnosis of acute renal failure. Kidney Int 62:2223–2229CrossRefPubMed
20.
Pepin MN, Bouchard J, Legault L, Ethier J (2007) Diagnostic performance of fractional excretion of urea and fractional excretion of sodium in the evaluations of patients with acute kidney injury with or without diuretic treatment. Am J Kidney Dis 50:566–573CrossRefPubMed
21.
Wo CC, Shoemaker WC, Appel PL, Bishop MH, Kram HB, Hardin E (1993) Unreliability of blood pressure and heart rate to evaluate cardiac output in emergency resuscitation and critical illness. Crit Care Med 21:218–223CrossRefPubMed
22.
Kjelland CB, Djogovic D (2010) The role of serum lactate in the acute care setting. J Intensive Care Med 25:286–300CrossRefPubMed
23.
Howell MD, Donnino M, Clardy P, Talmor D, Shapiro NI (2007) Occult hypoperfusion and mortality in patients with suspected infection. Intensive Care Med 33:1892–1899CrossRefPubMed
24.
Nguyen HB, Rivers EP, Knoblich BP, Jacobsen G, Muzzin A, Ressler JA et al (2004) Early lactate clearance is associated with improved outcome in severe sepsis and septic shock. Crit Care Med 32:1637–1642CrossRefPubMed
25.
Rudski LG, Lai WW, Afilalo J, Hua L, Handschumacher MD, Chandrasekaran K et al (2010) Guidelines for the echocardiographic assessment of the right heart in adults: a report from the American Society of Echocardiography endorsed by the European Association of Echocardiography, a registered branch of the European Society of Cardiology, and the Canadian Society of Echocardiography. J Am Soc Echocardiogr 23:685–713 (quiz 86–8)CrossRefPubMed
26.
Feissel M, Michard F, Faller JP, Teboul JL (2004) The respiratory variation in inferior vena cava diameter as a guide to fluid therapy. Intensive Care Med 30:1834–1837CrossRefPubMed
27.
Weekes AJ, Tassone HM, Babcock A, Quirke DP, Norton HJ, Jayarama K et al (2011) Comparison of serial qualitative and quantitative assessments of caval index and left ventricular systolic function during early fluid resuscitation of hypotensive emergency department patients. Acad Emerg Med 18:912–921CrossRefPubMed
28.
Tetsuka T, Ando Y, Ono S, Asano Y (1995) Change in inferior vena caval diameter detected by ultrasonography during and after hemodialysis. ASAIO J 41:105–110PubMed
29.
Fields JM, Lee PA, Jenq KY, Mark DG, Panebianco NL, Dean AJ (2011) The interrater reliability of inferior vena cava ultrasound by bedside clinician sonographers in emergency department patients. Acad Emerg Med 18:98–101CrossRefPubMed
30.
Yanagawa Y, Nishi K, Sakamoto T, Okada Y (2005) Early diagnosis of hypovolemic shock by sonographic measurement of inferior vena cava in trauma patients. J Trauma 58:825–829CrossRefPubMed
31.
Yanagawa Y, Sakamoto T, Okada Y (2007) Hypovolemic shock evaluated by sonographic measurement of the inferior vena cava during resuscitation in trauma patients. J Trauma 63:1245–1248 (discussion 8)CrossRefPubMed
32.
Sefidbakht S, Assadsangabi R, Abbasi HR, Nabavizadeh A (2007) Sonographic measurement of the inferior vena cava as a predictor of shock in trauma patients. Emerg Radiol 14:181–185CrossRefPubMed
33.
Corl K, Napoli AM, Gardiner F (2012) Bedside sonographic measurement of the inferior vena cava caval index is a poor predictor of fluid responsiveness in emergency department patients. Emerg Med Australas 24:534–539CrossRefPubMed
34.
Neskovic AN, Hagendorff A, Lancellotti P, Guarracino F, Varga A, Cosyns B et al (2013) Emergency echocardiography: the European Association of Cardiovascular Imaging recommendations. Eur Heart J Cardiovasc Imaging 14:1–11CrossRefPubMed
35.
Lancellotti P, Price S, Edvardsen T, Cosyns B, Neskovic AN, Dulgheru R et al (2015) The use of echocardiography in acute cardiovascular care: recommendations of the European Association of Cardiovascular Imaging and the Acute Cardiovascular Care Association. Eur Heart J Acute Cardiovasc Care 4:3–5CrossRefPubMed
36.
Levitov A, Marik PE (2012) Echocardiographic assessment of preload responsiveness in critically ill patients. Cardiol Res Pract 2012:819696PubMed
37.
Ely EW, Haponik EF (2002) Using the chest radiograph to determine intravascular volume status: the role of vascular pedicle width. Chest 121:942–950CrossRefPubMed
38.
Halperin BD, Feeley TW, Mihm FG, Chiles C, Guthaner DF, Blank NE (1985) Evaluation of the portable chest roentgenogram for quantitating extravascular lung water in critically ill adults. Chest 88:649–652CrossRefPubMed
39.
Milne EN, Pistolesi M, Miniati M, Giuntini C (1984) The vascular pedicle of the heart and the vena azygos. Part I: the normal subject. Radiology 152:1–8CrossRefPubMed
40.
Ely EW, Smith AC, Chiles C, Aquino SL, Harle TS, Evans GW et al (2001) Radiologic determination of intravascular volume status using portable, digital chest radiography: a prospective investigation in 100 patients. Crit Care Med 29:1502–1512CrossRefPubMed
41.
Theodoro D, Owens PL, Olsen MA, Fraser V (2014) Rates and timing of central venous cannulation among patients with sepsis and respiratory arrest admitted by the emergency department. Crit Care Med 42:554–564CrossRefPubMedPubMedCentral
42.
Reade MC, Huang DT, Bell D, Coats TJ, Cross AM, Moran JL et al (2010) Variability in management of early severe sepsis. Emerg Med J 27:110–115CrossRefPubMed
43.
Yealy DM, Kellum JA, Huang DT, Barnato AE, Weissfeld LA, Pike F et al (2014) A randomized trial of protocol-based care for early septic shock. N Engl J Med 370:1683–1693CrossRefPubMed
44.
Peake SL, Delaney A, Bailey M, Bellomo R, Cameron PA, Cooper DJ et al (2014) Goal-directed resuscitation for patients with early septic shock. N Engl J Med 371:1496–1506CrossRefPubMed
45.
Michard F, Alaya S, Zarka V, Bahloul M, Richard C, Teboul JL (2003) Global end-diastolic volume as an indicator of cardiac preload in patients with septic shock. Chest 124:1900–1908CrossRefPubMed
46.
Marik PE, Baram M, Vahid B (2008) Does central venous pressure predict fluid responsiveness? A systematic review of the literature and the tale of seven mares. Chest 134:172–178CrossRefPubMed
47.
Marik PE, Cavallazzi R (2013) Does the central venous pressure predict fluid responsiveness? An updated meta-analysis and a plea for some common sense. Crit Care Med 41:1774–1781CrossRefPubMed
48.
Cannesson M, Ramsingh D, Rinehart J, Demirjian A, Vu T, Vakharia S et al (2015) Perioperative goal-directed therapy and postoperative outcomes in patients undergoing high-risk abdominal surgery: a historical-prospective, comparative effectiveness study. Crit Care 19:261CrossRefPubMedPubMedCentral
49.
Monnet X, Rienzo M, Osman D, Anguel N, Richard C, Pinsky MR et al (2006) Passive leg raising predicts fluid responsiveness in the critically ill. Crit Care Med 34:1402–1407CrossRefPubMed
50.
Jabot J, Teboul JL, Richard C, Monnet X (2009) Passive leg raising for predicting fluid responsiveness: importance of the postural change. Intensive Care Med 35:85–90CrossRefPubMed
51.
52.
Preau S, Saulnier F, Dewavrin F, Durocher A, Chagnon JL (2010) Passive leg raising is predictive of fluid responsiveness in spontaneously breathing patients with severe sepsis or acute pancreatitis. Crit Care Med 38:819–825CrossRefPubMed
53.
Teboul JL, Monnet X (2008) Prediction of volume responsiveness in critically ill patients with spontaneous breathing activity. Curr Opin Crit Care 14:334–339CrossRefPubMed
54.
55.
Cavallaro F, Sandroni C, Marano C, La Torre G, Mannocci A, De Waure C et al (2010) Diagnostic accuracy of passive leg raising for prediction of fluid responsiveness in adults: systematic review and meta-analysis of clinical studies. Intensive Care Med 36:1475–1483CrossRefPubMed
56.
57.
Lakhal K, Ehrmann S, Benzekri-Lefevre D, Runge I, Legras A, Dequin PF et al (2012) Brachial cuff measurements of blood pressure during passive leg raising for fluid responsiveness prediction. Ann Fr Anesth Reanim 31:e67–e72CrossRefPubMed
58.
Lamia B, Ochagavia A, Monnet X, Chemla D, Richard C, Teboul JL (2007) Echocardiographic prediction of volume responsiveness in critically ill patients with spontaneously breathing activity. Intensive Care Med 33:1125–1132CrossRefPubMed
59.
Delerme S, Renault R, Le Manach Y, Lvovschi V, Bendahou M, Riou B et al (2007) Variations in pulse oximetry plethysmographic waveform amplitude induced by passive leg raising in spontaneously breathing volunteers. Am J Emerg Med 25:637–642CrossRefPubMed
60.
Cecconi M, Parsons AK, Rhodes A (2011) What is a fluid challenge? Curr Opin Crit Care 17:290–295CrossRefPubMed
61.
62.
Cherpanath TG, Aarts LP, Groeneveld JA, Geerts BF (2014) Defining fluid responsiveness: a guide to patient-tailored volume titration. J Cardiothorac Vasc Anesth 28:745–754CrossRefPubMed
63.
Michard F, Teboul JL (2002) Predicting fluid responsiveness in ICU patients: a critical analysis of the evidence. Chest 121:2000–2008CrossRefPubMed
64.
Muller L, Louart G, Teboul JL, Mahamat A, Polge A, Bertinchant JP et al (2009) Could B-type Natriuretic Peptide (BNP) plasma concentration be useful to predict fluid responsiveness [corrected] in critically ill patients with acute circulatory failure? Ann Fr Anesth Reanim 28:531–536CrossRefPubMed
65.
Araghi A, Bander JJ, Guzman JA (2006) Arterial blood pressure monitoring in overweight critically ill patients: invasive or noninvasive? Crit Care 10:R64CrossRefPubMedPubMedCentral
66.
Anastas ZM, Jimerson E, Garolis S (2008) Comparison of noninvasive blood pressure measurements in patients with atrial fibrillation. J Cardiovasc Nurs 23:519–524 (quiz 25–26)CrossRefPubMed
67.
68.
Wagner JY, Prantner JS, Meidert AS, Hapfelmeier A, Schmid RM, Saugel B (2014) Noninvasive continuous versus intermittent arterial pressure monitoring: evaluation of the vascular unloading technique (CNAP device) in the emergency department. Scand J Trauma Resusc Emerg Med 22:8CrossRefPubMedPubMedCentral
69.
Nowak RM, Sen A, Garcia AJ, Wilkie H, Yang JJ, Nowak MR et al (2011) Noninvasive continuous or intermittent blood pressure and heart rate patient monitoring in the ED. Am J Emerg Med 29:782–789CrossRefPubMed
70.
Saugel B, Dueck R, Wagner JY (2014) Measurement of blood pressure. Best Pract Res Clin Anaesthesiol 28:309–322CrossRefPubMed
71.
Saugel B, Meidert AS, Hapfelmeier A, Eyer F, Schmid RM, Huber W (2013) Non-invasive continuous arterial pressure measurement based on radial artery tonometry in the intensive care unit: a method comparison study using the T-Line TL-200pro device. Br J Anaesth 111:185–190CrossRefPubMed
72.
Meidert AS, Huber W, Muller JN, Schofthaler M, Hapfelmeier A, Langwieser N et al (2014) Radial artery applanation tonometry for continuous non-invasive arterial pressure monitoring in intensive care unit patients: comparison with invasively assessed radial arterial pressure. Br J Anaesth 112:521–528CrossRefPubMed
73.
Saugel B, Meidert AS, Langwieser N, Wagner JY, Fassio F, Hapfelmeier A et al (2014) An autocalibrating algorithm for non-invasive cardiac output determination based on the analysis of an arterial pressure waveform recorded with radial artery applanation tonometry: a proof of concept pilot analysis. J Clin Monit Comput 28:357–362CrossRefPubMed
74.
Wagner JY, Sarwari H, Schon G, Kubik M, Kluge S, Reichenspurner H et al (2015) Radial artery applanation tonometry for continuous noninvasive cardiac output measurement: a comparison with intermittent pulmonary artery thermodilution in patients after cardiothoracic surgery. Crit Care Med 43:1423–1428CrossRefPubMed
75.
Saugel B, Cecconi M, Wagner JY, Reuter DA (2015) Noninvasive continuous cardiac output monitoring in perioperative and intensive care medicine. Br J Anaesth 114:562–575CrossRefPubMed
76.
Cecconi M, Monge Garcia MI, Gracia Romero M, Mellinghoff J, Caliandro F, Grounds RM et al (2015) The use of pulse pressure variation and stroke volume variation in spontaneously breathing patients to assess dynamic arterial elastance and to predict arterial pressure response to fluid administration. Anesth Analg 120(1):76–84CrossRefPubMed
77.
Saugel B, Reuter DA (2014) Are we ready for the age of non-invasive haemodynamic monitoring? Br J Anaesth 113:340–343CrossRefPubMed
78.
Wagner JY, Saugel B (2015) When should we adopt continuous noninvasive hemodynamic monitoring technologies into clinical routine? J Clin Monit Comput 29:1–3CrossRefPubMed
Metadaten
Titel
Assessment of volume status and fluid responsiveness in the emergency department: a systematic approach
verfasst von
C. Maurer, MD
J. Y. Wagner, MD
R. M. Schmid, MD
B. Saugel, MD
Publikationsdatum
16.12.2015
Verlag
Springer Medizin
Erschienen in
Medizinische Klinik - Intensivmedizin und Notfallmedizin / Ausgabe 4/2017
Print ISSN: 2193-6218
Elektronische ISSN: 2193-6226
DOI
https://doi.org/10.1007/s00063-015-0124-x

Weitere Artikel der Ausgabe 4/2017

Medizinische Klinik - Intensivmedizin und Notfallmedizin 4/2017 Zur Ausgabe

Physiotherapie

Physiotherapeutische Intervention auf der Intensivstation

Kasuistiken

Schwere Exazerbation einer beatmungspflichtigen COPD

Leitthema

Intensivmedizin im Alter

Mitteilungen der DGIIN

Mitteilungen der DGIIN

Leitthema

Extrakorporale Membranoxygenierung

Leitthema

Maßgeschneiderte Frühmobilisation

Neu im Fachgebiet AINS

24.04.2024 | DGIM 2024 | Kongressbericht | Nachrichten

Magen-Darm-Blutungen werden präklinisch oft falsch eingeschätzt

23.04.2024 | DGIM 2024 | Kongressbericht | Nachrichten

Sepsis-Verdacht: Eine Stunde, fünf essenzielle Maßnahmen

23.04.2024 | Appendizitis | Nachrichten

Hinter dieser Appendizitis steckte ein Erreger

23.04.2024 | Leitsymptom Rückenschmerzen | Nachrichten

Ärztliche Empathie hilft gegen Rückenschmerzen
weitere anzeigen

Update AINS

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

hier abonnieren