The time cost of physiologically ineffective intravenous fluids in the emergency department: an observational pilot study employing wearable Doppler ultrasound
Abstract Background Little data exist on the time spent by emergency department (ED) personnel providing intravenous (IV) fluid to ‘responsive’ versus ‘unresponsive’ patients. Methods A prospective, convenience sample of adult ED patients was studied; patients were enrolled if preload expansion was...
| Main Authors: | , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2023-02-01
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| Series: | Journal of Intensive Care |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s40560-023-00655-6 |
| _version_ | 1797865492730347520 |
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| author | Jon-Émile S. Kenny Stanley O. Gibbs Delaney Johnston Zhen Yang Lisa M. Hofer Mai Elfarnawany Joseph K. Eibl Amanda Johnson Anthony J. Buecker Vivian C. Lau Benjamin O. Kemp |
| author_facet | Jon-Émile S. Kenny Stanley O. Gibbs Delaney Johnston Zhen Yang Lisa M. Hofer Mai Elfarnawany Joseph K. Eibl Amanda Johnson Anthony J. Buecker Vivian C. Lau Benjamin O. Kemp |
| author_sort | Jon-Émile S. Kenny |
| collection | DOAJ |
| description | Abstract Background Little data exist on the time spent by emergency department (ED) personnel providing intravenous (IV) fluid to ‘responsive’ versus ‘unresponsive’ patients. Methods A 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. Results 53 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.’ Conclusions We 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. |
| first_indexed | 2024-04-09T23:08:41Z |
| format | Article |
| id | doaj.art-b7d18ac40a4b4850a55ae51dc8172abe |
| institution | Directory Open Access Journal |
| issn | 2052-0492 |
| language | English |
| last_indexed | 2024-04-09T23:08:41Z |
| publishDate | 2023-02-01 |
| publisher | BMC |
| record_format | Article |
| series | Journal of Intensive Care |
| spelling | doaj.art-b7d18ac40a4b4850a55ae51dc8172abe2023-03-22T10:32:47ZengBMCJournal of Intensive Care2052-04922023-02-011111910.1186/s40560-023-00655-6The time cost of physiologically ineffective intravenous fluids in the emergency department: an observational pilot study employing wearable Doppler ultrasoundJon-Émile S. Kenny0Stanley O. Gibbs1Delaney Johnston2Zhen Yang3Lisa M. Hofer4Mai Elfarnawany5Joseph K. Eibl6Amanda Johnson7Anthony J. Buecker8Vivian C. Lau9Benjamin O. Kemp10Health Sciences North Research InstituteFlosonics Medical 325 W. Front StreetFlosonics Medical 325 W. Front StreetFlosonics Medical 325 W. Front StreetFlosonics Medical 325 W. Front StreetFlosonics Medical 325 W. Front StreetHealth Sciences North Research InstituteOSF Saint Francis Medical CenterOSF Saint Francis Medical CenterOSF Saint Francis Medical CenterOSF Saint Francis Medical CenterAbstract Background Little data exist on the time spent by emergency department (ED) personnel providing intravenous (IV) fluid to ‘responsive’ versus ‘unresponsive’ patients. Methods A 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. Results 53 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.’ Conclusions We 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.https://doi.org/10.1186/s40560-023-00655-6Doppler ultrasoundCarotid arteryFluid responsivenessFluid refractoryQuality improvementPersonalized medicine |
| spellingShingle | Jon-Émile S. Kenny Stanley O. Gibbs Delaney Johnston Zhen Yang Lisa M. Hofer Mai Elfarnawany Joseph K. Eibl Amanda Johnson Anthony J. Buecker Vivian C. Lau Benjamin O. Kemp The time cost of physiologically ineffective intravenous fluids in the emergency department: an observational pilot study employing wearable Doppler ultrasound Journal of Intensive Care Doppler ultrasound Carotid artery Fluid responsiveness Fluid refractory Quality improvement Personalized medicine |
| title | The time cost of physiologically ineffective intravenous fluids in the emergency department: an observational pilot study employing wearable Doppler ultrasound |
| title_full | The time cost of physiologically ineffective intravenous fluids in the emergency department: an observational pilot study employing wearable Doppler ultrasound |
| title_fullStr | The time cost of physiologically ineffective intravenous fluids in the emergency department: an observational pilot study employing wearable Doppler ultrasound |
| title_full_unstemmed | The time cost of physiologically ineffective intravenous fluids in the emergency department: an observational pilot study employing wearable Doppler ultrasound |
| title_short | The time cost of physiologically ineffective intravenous fluids in the emergency department: an observational pilot study employing wearable Doppler ultrasound |
| title_sort | time cost of physiologically ineffective intravenous fluids in the emergency department an observational pilot study employing wearable doppler ultrasound |
| topic | Doppler ultrasound Carotid artery Fluid responsiveness Fluid refractory Quality improvement Personalized medicine |
| url | https://doi.org/10.1186/s40560-023-00655-6 |
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