Increased mortality and morbidity in the critical care unit have been linked to fluid overload and venous congestion (intensive care unit). Although diuretics are commonly used to restore fluid balance, there is little evidence linking the resulting fluid loss to clinical benefit. The purpose of this research was to compare the VEXUS (venous ultrasound congestion score), the portal pulsatility index, and the renal venous impedance index in their capacity to predict adequate diuretic-induced fluid depletion. The research was performed at a medical-surgical intensive care unit linked with a university and was prospective, observational, and single-center. The clinical decision to initiate loop diuretic therapy in adults. Inclusion and 2 hours after starting the diuretics were followed by a battery of hemodynamic and ultrasound tests (including the portal pulsatility index, renal venous impedance index, and VEXUS score). Patients’ demographics were recorded at the time of admission, after 24 hours, and after their release from the intensive care unit. After diuretic fluid depletion, a congestive score of less than 3 indicated adequate fluid depletion. Clinical and molecular markers of congestion were used to create the congestive score. About 81 patients were included, and 43 (53%) had a high congestion score to warrant clinical attention. Diuretic-induced fluid depletion was successfully managed in 34 individuals (42%). No significant differences were seen in any of the left- and right-sided echocardiographic parameters between the 2 groups. The renal venous impedance index (AUC = 0.80, CI95%:0.70–0.92, P= 0.001), followed by the renal venous impedance index (AUC = 0.72, CI95% 0.61–0.84, P=0.001) at baseline were the greatest predictors of adequate response to diuretic-induced fluid depletion. The baseline did not well predict the appropriate response to diuretic-induced fluid depletion VEXUS score The baseline VEXUS score (AUC of 0.66 CI95% 0.53–0.79, P=0.012) Predicting the correct response to diuretic-induced fluid depletion in intensive care unit patients was the portal pulsatility index and renal venous impedance index. It is recommended that future randomized research assess the portal pulsatility index.
Source: ccforum.biomedcentral.com/articles/10.1186/s13054-022-04180-0
