Unifying Fluid Responsiveness and Tolerance With Physiology: A Dynamic Interpretation of the Diamond–Forrester Classification
| Autor: | Jon-Émile S. Kenny, MD, MSc, Ross Prager, MD, Philippe Rola, MD, Korbin Haycock, MD, John Basmaji, MD, Glenn Hernández, MD, PhD |
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| Jazyk: | angličtina |
| Rok vydání: | 2023 |
| Předmět: | |
| Zdroj: | Critical Care Explorations, Vol 5, Iss 12, p e1022 (2023) |
| Druh dokumentu: | article |
| ISSN: | 2639-8028 00000000 |
| DOI: | 10.1097/CCE.0000000000001022 |
| Popis: | Point of care ultrasound (POCUS) is a first-line tool to assess hemodynamically unstable patients, however, there is confusion surrounding intertwined concepts such as: “flow,” “congestion,” “fluid responsiveness (FR),” and “fluid tolerance.” We argue that the Frank–Starling relationship is clarifying because it describes the interplay between “congestion” and “flow” on the x-axis and y-axis, respectively. Nevertheless, a single, simultaneous assessment of congestion and flow via POCUS remains a static approach. To expand this, we propose a two-step process. The first step is to place the patient on an ultrasonographic Diamond–Forrester plot. The second step is a dynamic assessment for FR (e.g., passive leg raise), which individualizes therapy across the arc of critical illness. |
| Databáze: | Directory of Open Access Journals |
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