Reliability of point-of-care ultrasound to evaluate fluid tolerance performed by critical care residents
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 critic...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2023-10-01
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| Series: | European Journal of Medical Research |
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| Online Access: | https://doi.org/10.1186/s40001-023-01397-9 |
| _version_ | 1797577340555886592 |
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| author | Manuel A. Guerrero-Gutiérrez Francisco Javier García-Guillén Humberto Adame-Encarnación Fernando Monera-Martínez Silvio A. Ñamendys-Silva Bertha M. Córdova-Sánchez |
| author_facet | Manuel A. Guerrero-Gutiérrez Francisco Javier García-Guillén Humberto Adame-Encarnación Fernando Monera-Martínez Silvio A. Ñamendys-Silva Bertha M. Córdova-Sánchez |
| author_sort | Manuel A. Guerrero-Gutiérrez |
| collection | DOAJ |
| description | 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. |
| first_indexed | 2024-03-10T22:06:52Z |
| format | Article |
| id | doaj.art-ed9c0a3bb1dd4e72aa2d526a43152e2a |
| institution | Directory Open Access Journal |
| issn | 2047-783X |
| language | English |
| last_indexed | 2024-03-10T22:06:52Z |
| publishDate | 2023-10-01 |
| publisher | BMC |
| record_format | Article |
| series | European Journal of Medical Research |
| spelling | doaj.art-ed9c0a3bb1dd4e72aa2d526a43152e2a2023-11-19T12:46:36ZengBMCEuropean Journal of Medical Research2047-783X2023-10-012811710.1186/s40001-023-01397-9Reliability of point-of-care ultrasound to evaluate fluid tolerance performed by critical care residentsManuel A. Guerrero-Gutiérrez0Francisco Javier García-Guillén1Humberto Adame-Encarnación2Fernando Monera-Martínez3Silvio A. Ñamendys-Silva4Bertha M. Córdova-Sánchez5Instituto Nacional de CancerologíaInstituto Nacional de CancerologíaInstituto Nacional de CancerologíaInstituto Nacional de CancerologíaInstituto Nacional de CancerologíaInstituto Nacional de CancerologíaAbstract 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.https://doi.org/10.1186/s40001-023-01397-9AgreementInferior vena cavaJugular veinTime velocity integralVenous excess ultrasound |
| spellingShingle | Manuel A. Guerrero-Gutiérrez Francisco Javier García-Guillén Humberto Adame-Encarnación Fernando Monera-Martínez Silvio A. Ñamendys-Silva Bertha M. Córdova-Sánchez Reliability of point-of-care ultrasound to evaluate fluid tolerance performed by critical care residents European Journal of Medical Research Agreement Inferior vena cava Jugular vein Time velocity integral Venous excess ultrasound |
| title | Reliability of point-of-care ultrasound to evaluate fluid tolerance performed by critical care residents |
| title_full | Reliability of point-of-care ultrasound to evaluate fluid tolerance performed by critical care residents |
| title_fullStr | Reliability of point-of-care ultrasound to evaluate fluid tolerance performed by critical care residents |
| title_full_unstemmed | Reliability of point-of-care ultrasound to evaluate fluid tolerance performed by critical care residents |
| title_short | Reliability of point-of-care ultrasound to evaluate fluid tolerance performed by critical care residents |
| title_sort | reliability of point of care ultrasound to evaluate fluid tolerance performed by critical care residents |
| topic | Agreement Inferior vena cava Jugular vein Time velocity integral Venous excess ultrasound |
| url | https://doi.org/10.1186/s40001-023-01397-9 |
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