The time cost of physiologically ineffective intravenous fluids in the emergency department: an observational pilot study employing wearable Doppler ultrasound

Journal of Intensive Care

Research

Stanley O. Gibbs¹  Mai Elfarnawany¹  Zhen Yang¹  Delaney Johnston¹  Lisa M. Hofer¹  Jon-Émile S. Kenny²  Joseph K. Eibl³  Amanda Johnson⁴  Benjamin O. Kemp⁴  Vivian C. Lau⁴  Anthony J. Buecker⁴ 

[1] Flosonics Medical 325 W. Front Street, M5V2Y1, Toronto, ON, Canada;Health Sciences North Research Institute, 56 Walford Road, P3E2H3, Sudbury, ON, Canada;Flosonics Medical 325 W. Front Street, M5V2Y1, Toronto, ON, Canada;Health Sciences North Research Institute, 56 Walford Road, P3E2H3, Sudbury, ON, Canada;Flosonics Medical 325 W. Front Street, M5V2Y1, Toronto, ON, Canada;Northern Ontario School of Medicine, 935 Ramsey Lake Road, P3E2C6, Sudbury, ON, Canada;OSF Saint Francis Medical Center, 530 NE Glen Oak Ave, 61637, Peoria, IL, USA;

关键词: Doppler ultrasound;    Carotid artery;    Fluid responsiveness;    Fluid refractory;    Quality improvement;    Personalized medicine;    Wearable technology;   

DOI  :  10.1186/s40560-023-00655-6

 received in 2022-08-22, accepted in 2023-02-06,  发布年份 2023

来源: Springer

【 摘 要 】

BackgroundLittle data exist on the time spent by emergency department (ED) personnel providing intravenous (IV) fluid to ‘responsive’ versus ‘unresponsive’ patients.MethodsA prospective, convenience sample of adult ED patients was studied; patients were enrolled if preload expansion was indicated for any reason. Using a novel, wireless, wearable ultrasound, carotid artery Doppler was obtained before and throughout a preload challenge (PC) prior to each bag of ordered IV fluid. The treating clinician was blinded to the results of the ultrasound. IV fluid was deemed ‘effective’ or ‘ineffective’ based on the greatest change in carotid artery corrected flow time (ccFT∆) during the PC. The duration, in minutes, of each bag of IV fluid administered was recorded.Results53 patients were recruited and 2 excluded for Doppler artifact. There were 86 total PCs included in the investigation comprising 81.7 L of administered IV fluid. 19,667 carotid Doppler cardiac cycles were analyzed. Using ccFT∆ ≥  + 7 ms to discriminate ‘physiologically effective’ from ‘ineffective’ IV fluid, we observed that 54 PCs (63%) were ‘effective’, comprising 51.7 L of IV fluid, whereas, 32 (37%) were ‘ineffective’ comprising 30 L of IV fluid. 29.75 total hours across all 51 patients were spent in the ED providing IV fluids categorized as ‘ineffective.’ConclusionsWe report the largest-known carotid artery Doppler analysis (i.e., roughly 20,000 cardiac cycles) in ED patients requiring IV fluid expansion. A clinically significant amount of time was spent providing physiologically ineffective IV fluid. This may represent an avenue to improve ED care efficiency.

【 授权许可】

CC BY   
© The Author(s) 2023

【 图 表 】

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