The Korean Journal of Medicine

The Korean Association of Internal Medicine (대한내과학회)
권호 표지

Evaluation and Management of Volume Status: A Practical View

체액량 평가와 수액요법: 실제적인 면 중심으로

  • Kim, Se-Joong (Department of Internal Medicine, Gachon University School of Medicine)
  • 김세중 (가천의과학대학교 의학전문대학원 내과학교실)
  • Published : 2011.01.01
⟨ Previous Next ⟩

Abstract

Objective, rapid, and accurate assessment of volume status is important in the early management of acute, critical illnesses, as inappropriate therapy may lead to interventions with fatal outcomes. Traditionally, the history and physical examinations have been used for this assessment, but have limitations. Radioisotopic measurement or invasive hemodynamic monitoring is impractical, complicated, and expensive. Recently developed technologies offer rapid, accurate estimation of volume status with the potential to improve clinical outcome. This review discusses the methods available for volume assessment, including ultrasound, bioimpedance, and the historical tools.

Keywords

References

  1. Wuerz RC, Meador SA. Effects of prehospital medications on mortality and length of stay in congestive heart failure. Ann Emerg Med 1992;21:669-674. https://doi.org/10.1016/S0196-0644(05)82777-5
  2. Wang CS, FitzGerald JM, Schulzer M, Mak E, Ayas NT. Does this dyspneic patient in the emergency department have congestive heart failure? JAMA 2005;294:1944-1956. https://doi.org/10.1001/jama.294.15.1944
  3. Gross CR, Lindquist RD, Woolley AC, Granieri R, Allard K, Webster B. Clinical indicators of dehydration severity in elderly patients. J Emerg Med 1992;10:267-274. https://doi.org/10.1016/0736-4679(92)90331-M
  4. Drazner MH, Rame JE, Stevenson LW, Dries DL. Prognostic importance of elevated jugular venous pressure and a third heart sound in patients with heart failure. N Engl J Med 2001;345: 574-581. https://doi.org/10.1056/NEJMoa010641
  5. Butman SM, Ewy GA, Standen JR, Kern KB, Hahn E. Bedside cardiovascular examination in patients with severe chronic heart failure: importance of rest or inducible jugular venous distension. J Am Coll Cardiol 1993;22:968-974. https://doi.org/10.1016/0735-1097(93)90405-P
  6. Marantz PR, Kaplan MC, Alderman MH. Clinical diagnosis of congestive heart failure in patients with acute dyspnea. Chest 1990;97:776-781. https://doi.org/10.1378/chest.97.4.776
  7. Stevenson LW, Perloff JK. The limited reliability of physical signs for estimating hemodynamics in chronic heart failure. JAMA 1989;261:884-888. https://doi.org/10.1001/jama.1989.03420060100040
  8. McGee S, Abernethy WB 3rd, Simel DL. The rational clinical examination. Is this patient hypovolemic? JAMA 1999;281: 1022-1029. https://doi.org/10.1001/jama.281.11.1022
  9. Le Conte P, Coutant V, N'Guyen JM, Baron D, Touze MD, Potel G. Prognostic factors in acute cardiogenic pulmonary edema. Am J Emerg Med 1999;17:329-332.
  10. Koziol-McLain J, Lowenstein SR, Fuller B. Orthostatic vital signs in emergency department patients. Ann Emerg Med 1991;20: 606-610. https://doi.org/10.1016/S0196-0644(05)82376-5
  11. Weiss A, Grossman E, Beloosesky Y, Grinblat J. Orthostatic hypotension in acute geriatric ward: is it a consistent finding? Arch Intern Med 2002;162:2369-2374. https://doi.org/10.1001/archinte.162.20.2369
  12. Drazner MH, Hamilton MA, Fonarow G, Creaser J, Flavell C, Stevenson LW. Relationship between right and left-sided filling pressures in 1000 patients with advanced heart failure. J Heart Lung Transplant 1999;18:1126-1132. https://doi.org/10.1016/S1053-2498(99)00070-4
  13. Chait A, Cohen HE, Meltzer LE, VanDurme JP. The bedside chest radiograph in the evaluation of incipient heart failure. Radiology 1972;105:563-566. https://doi.org/10.1148/105.3.563
  14. Koga Y, Wada T, Toshima H, Akazawa K, Nose Y. Prognostic significance of electrocardiographic findings in patients with dilated cardiomyopathy. Heart Vessels 1993;8:37-41. https://doi.org/10.1007/BF02630564
  15. Kono T, Suwa M, Hanada H, Hirota Y, Kawamura K. Clinical significance of normal cardiac silhouette in dilated cardiomyopathy- evaluation based upon echocardiography and magnetic resonance imaging. Jpn Circ J 1992;56:359-365. https://doi.org/10.1253/jcj.56.359
  16. Piccoli A, Rossi B, Pillon L, Bucciante G. A new method for monitoring body fluid variation by bioimpedance analysis: the RXc graph. Kidney Int 1994;46:534-539. https://doi.org/10.1038/ki.1994.305
  17. Pillon L, Piccoli A, Lowrie EG, Lazarus JM, Chertow GM. Vector length as a proxy for the adequacy of ultrafiltration in hemodialysis. Kidney Int 2004;66:1266-1271. https://doi.org/10.1111/j.1523-1755.2004.00881.x
  18. Parrinello G, Paterna S, Di Pasquale P, et al. The usefulness of bioelectrical impedance analysis in differentiating dyspnea due to decompensated heart failure. J Card Fail 2008;14:676-686. https://doi.org/10.1016/j.cardfail.2008.04.005
  19. Lichtenstein DA, Lascols N, Mezière G, Gepner A. Ultrasound diagnosis of alveolar consolidation in the critically ill. Intensive Care Med 2004;30:276-281. https://doi.org/10.1007/s00134-003-2075-6
  20. Picano E, Frassi F, Agricola E, Gligorova S, Gargani L, Mottola G. Ultrasound lung comets: a clinically useful sign of extravascular lung water. J Am Soc Echocardiogr 2006;19:356-363. https://doi.org/10.1016/j.echo.2005.05.019
  21. Katzarski KS, Nisell J, Randmaa I, Danielsson A, Freyschuss U, Bergstrom J. A critical evaluation of ultrasound measurement of inferior vena cava diameter in assessing dry weight in normotensive and hypertensive hemodialysis patients. Am J Kidney Dis 1997;30:459-465.
  22. Lyon M, Blaivas M, Brannam L. Sonographic measurement of the inferior vena cava as a marker of blood loss. Am J Emerg Med 2005;23:45-50. https://doi.org/10.1016/j.ajem.2004.01.004
  23. Collins SP, Peacock WF, Lindsell CJ, et al. S3 detection as a diagnostic and prognostic aid in emergency department patients with acute dyspnea. Ann Emerg Med 2009;53:748-757. https://doi.org/10.1016/j.annemergmed.2008.12.029
  24. Summers RL, Shoemaker WC, Peacock WF, Ander DS, Coleman TG. Bench to bedside: electrophysiologic and clinical principles of noninvasive hemodynamic monitoring using impedance cardiography. Acad Emerg Med 2003;10:669-680. https://doi.org/10.1111/j.1553-2712.2003.tb00054.x
  25. Vincent JL, Weil MH. Fluid challenge revisited. Crit Care Med 2006;34:1333-1337. https://doi.org/10.1097/01.CCM.0000214677.76535.A5
  26. Collins SP, Lindsell CJ, Peacock WF 4th, Hedger VD, Storrow AB. The effect of treatment on the presence of abnormal heart sounds in emergency department patients with heart failure. Am J Emerg Med 2006;24:25-32. https://doi.org/10.1016/j.ajem.2005.06.005
  27. Kazanegra R, Cheng V, Garcia A, et al. A rapid test for B-type natriuretic peptide correlates with falling wedge pressures in patients treated for decompensated heart failure: a pilot study. J Card Fail 2001;7:21-29. https://doi.org/10.1054/jcaf.2001.23355
  28. Collins SP, Lindsell CJ, Storrow AB, Abraham WT. Prevalence of negative chest radiography results in the emergency department patient with decompensated heart failure. Ann Emerg Med 2006;47:13-18. https://doi.org/10.1016/j.annemergmed.2005.04.003
  29. Studler U, Kretzschmar M, Christ M, et al. Accuracy of chest radiographs in the emergency diagnosis of heart failure. Eur Radiol 2008;18:1644-1652. https://doi.org/10.1007/s00330-008-0930-0
  30. Kataoka H, Takada S. The role of thoracic ultrasonography for evaluation of patients with decompensated chronic heart failure. J Am Coll Cardiol 2000;35:1638-1646. https://doi.org/10.1016/S0735-1097(00)00602-1
  31. Blehar DJ, Dickman E, Gaspari R. Identification of congestive heart failure via respiratory variation of inferior vena cava diameter. Am J Emerg Med 2009;27:71-75. https://doi.org/10.1016/j.ajem.2008.01.002
  32. Mebazaa A, Gheorghiade M, Pina IL, et al. Practical recommendations for prehospital and early in-hospital management of patients presenting with acute heart failure syndromes. Crit Care Med 2008;36(1 Suppl):S129-S139. https://doi.org/10.1097/01.CCM.0000296274.51933.4C
  33. Piccoli A, Pittoni G, Facco E, Favaro E, Pillon L. Relationship between central venous pressure and bioimpedance vector analysis in critically ill patients. Crit Care Med 2000;28:132-137. https://doi.org/10.1097/00003246-200001000-00022
  34. Di Somma S, Gori CS, Grandi T, Risicato MG, Salvatori E. Fluid assessment and management in the emergency department. Contrib Nephrol 2010;164:227-236.