Dobrusskin, M.C. (Maria Cecilia) (2017) Spoedechografie op de SEH:herhaalde vena cava metingen voor beoordelen van volumerespons. thesis, Medicine.
Full text available on request.Abstract
Every year a large number of patients in need of fluid resuscitation is brought to the emergency department (ED). Patients who have lost a large amount of fluid, who are in fluid demand, or of whom fluid leaks into the interstitial compartments can enter a state of hypovolemic shock when not treated correctly. One of the main treatments is fluid replacement therapy. Before fluid resuscitation a correct assumption on the intravascular volume status must be made. It is also important to know whether the patient will be fluid responsive or not. Unfortunately, there still isn’t a gold standard to guide fluid resuscitation. This study focused on investigating if ultrasound imaging of the inferior vena cava (IVC) and the tidal changes in diameter during spontaneous breathing, caval index (CI), could be used as a method to guide fluid replacement therapy in the ED setting. This study was set up as an observational study set in the ED of the UMCG. Patients were included in the period from February to august. Patients had to meet several criteria before being included. The patient should have an indication for receiving a fluid bolus of at least 500ml. In total 52 patients were included. An ultrasound of the IVC was made before as well as after receiving the bolus. Simultaneously the vital values were recorded. To determine whether IVC ultrasound can distinguish between patients who will show a positive change following fluid therapy and those who won’t, patients were divided into groups in two different ways. Patients were divided into a hypovolemic (CI≥36.5%) and a non-hypovolemic (CI<36.5%) group and into caval responders and non-caval responders depending on whether the patient showed a drop in CI (%) of at least 10 or not. For both ways of dividing the groups it was checked whether vital signs or caval values showed differences between the group, and, if they changed differently after applying fluid therapy. When divided in a hypovolemic and a non-hypovolemic group the vital values did not show any significant difference between the two groups (p>0.05). The hypovolemic group did show a significant change in maximal diameter (p=0.014), minimal diameter (p=0.000), and caval index (p=0.000) after resuscitation. The non-hypovolemic group did not show any significant changes in caval values (p>0.05). A significant difference in primary measurement of temperature (°C) (p=0.027), change in mean arterial pressure (MAP) (p=0.009), creatinine (p=0.037), and blood urea (p=0.044) were measured when dividing the study population into a caval responding and a non-caval responding group. Caval responders had a mean CI of 73% when first measured and showed a significant rise in minimal diameter (p=0.000). The non-caval responding group had a mean CI of 34%. This group showed a significant rise in maximal diameter (p=0.015) after fluid therapy. Also, a strong positive correlation (rp=0.759, p=0.000) was found between the initial CI and the drop in CI after volume therapy. In conclusion, ultrasonography of the IVC prior to fluid resuscitation can predict whether the patient will show a caval response after fluid therapy, and thus a rise in preload.
| Item Type: | Thesis (Thesis) |
|---|---|
| Supervisor name: | Primair begeleider: and Olgers, Drs. T.J. internist and Secundair begeleider: and ter Maaten, Prof. Dr. J.C. internist and Spoedeisende hulp afdeling, UMCG |
| Faculty: | Medical Sciences |
| Date Deposited: | 25 Jun 2020 11:08 |
| Last Modified: | 25 Jun 2020 11:08 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/2729 |
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