My brief thoughts on this interesting study, that I was privileged to be part of. I performed and reviewed some of the scans and helped with the manuscript. (1/3)
My brief thoughts on this interesting study, that I was privileged to be part of. I performed and reviewed some of the scans and helped with the manuscript. (1/3)
When I started on this #VEXUS journey, I was (naively) hopeful that we finally had an accurate #pocus marker for fluid status. This study demonstrates that we don’t. #VEXUS is far more influenced by RA pressure than it is by overall blood volume (2/3)
However, if your RA pressure is high (for whatever reason), fluid removal can lower it. With work by @ross_prager demonstrating that fluid responsiveness and a high RA pressure can coexist, we have many more questions than answers to #pocus and “volume state” /Fin
@iceman_ex @ross_prager VEXUS is not going to be an independent variable in terms of venous congestion. 1) ? added sens/spec to our current tests 2) ? Larger studies, we’re still talking small peas in terms of pt numbers 3) ? Worth learning at this stage of evolution. ? FUSICHD took this on too early.
@iceman_ex @ross_prager Yes, fluid removal is one way. You may also/alternately need inotropes, thrombolysis, ptca for rca, getting to frc with peep, inhaled pulmonary vasodilators, etc…
@iceman_ex @ross_prager Completely agree! In the end, even if would measure blood volume with the new techniques...what to do... ICU care is balancing harms (congestion) and benefits (more DO2) in individual patients and VEXUS really helps to estimate potential harm more granular than just a CVP