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Open Access 01-12-2023 | Ultrasound | Research

Reliability of point-of-care ultrasound to evaluate fluid tolerance performed by critical care residents

Authors: Manuel A. Guerrero-Gutiérrez, Francisco Javier García-Guillén, Humberto Adame-Encarnación, Fernando Monera-Martínez, Silvio A. Ñamendys-Silva, Bertha M. Córdova-Sánchez

Published in: European Journal of Medical Research | Issue 1/2023

Abstract

Background

Patients with hypotension usually receive intravenous fluids, but only 50% will respond to fluid administration. We aimed to assess the intra and interobserver agreement to evaluate fluid tolerance through diverse ultrasonographic methods.

Methods

We prospectively included critically ill patients on mechanical ventilation. One trained intensivist and two intensive care residents obtained the left ventricular outflow tract velocity–time integral (VTI) variability, inferior vena cava (IVC) distensibility index, internal jugular vein (IJV) distensibility index, and each component of the venous excess ultrasound (VExUS) system. We obtained the intraclass correlation coefficient (ICC) and Gwet’s first-order agreement coefficient (AC1), as appropriate.

Results

We included 32 patients. In-training observers were unable to assess the VTI-variability in two patients. The interobserver agreement was moderate to evaluate the IJV-distensibility index (AC1 0.54, CI 95% 0.29–0.80), fair to evaluate VTI-variability (AC1 0.39, CI 95% 0.12–0.66), and absent to evaluate the IVC-distensibility index (AC1 0.19, CI 95% − 0.07 to 0.44). To classify patients according to their VExUS grade, the intraobserver agreement was good, and the interobserver agreement was moderate (AC1 0.52, CI 95% 0.34–0.69).

Conclusions

Point-of-care ultrasound is frequently used to support decision-making in fluid management. However, we observed that the VTI variability and IVC-distensibility index might require further training of the ultrasound operators to be clinically useful. Our findings suggest that the IJV-distensibility index and the VExUS system have acceptable reproducibility among in-training observers.

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Title: Reliability of point-of-care ultrasound to evaluate fluid tolerance performed by critical care residents
Authors: Manuel A. Guerrero-Gutiérrez
Francisco Javier García-Guillén
Humberto Adame-Encarnación
Fernando Monera-Martínez
Silvio A. Ñamendys-Silva
Bertha M. Córdova-Sánchez
Publication date: 01-12-2023
Publisher: BioMed Central
Keywords: Ultrasound
Ultrasound
Care
Published in: European Journal of Medical Research / Issue 1/2023
Electronic ISSN: 2047-783X
DOI: https://doi.org/10.1186/s40001-023-01397-9

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Reliability of point-of-care ultrasound to evaluate fluid tolerance performed by critical care residents

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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