The Search for the Holy Grail: Assessment of Fluid Responsiveness

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Last week our residents and faculty met for journal club in search of the holy grail.. err.. I mean, to talk about ways to assess volume responsiveness.  A couple of weeks back the PGY-1 and 2  residents met and discussed a number of questions they had about the care and management of patients with sepsis.  The discussion hit on a number of key topics: empiric antibiotic selection, timing of antibiotics, choice of vasopressors, etc.  Ultimately the group decided they wanted to take a closer look at non-invasive ways to assess volume responsiveness and guide resuscitation in septic patients.  After searching the literature, they decided to take a closer look at these articles:

  1. Kanji, H., McCallum, J., Sirounis, D., MacRedmond, R., Moss, R., & Boyd, J. (2014). Limited echocardiography-guided therapy in subacute shock is associated with change in management and improved outcomes. Journal of Critical Care, 29(5), 700–705. doi:10.1016/j.jcrc.2014.04.008
  2. Duus N, et al, The reliability and validity of passive leg raise and fluid bolus to assess fluid responsiveness in spontaneously breathing emergency department patients, J Crit Care (2014), http://dx.doi.org/10.1016/j.jcrc.2014.07.031
  3. Kupersztych-Hagege, E., Teboul, J., Artigas, A., Sabatier, C., Richard, C., & Monnet, X. (2013) Bioreactance is not reliable for estimating cardiac output and the effects of passive leg raising in critically ill patients. British Journal of Anaesthesia. 11(6). doi:10.1093/bja/aet282 

Here are the analysis sheets for each of the papers:

Duus, et al, 2013

Duus, et al, 2013

Hagege, 2013

Hagege, 2013

Kanji, et al, 2014

Kanji, et al, 2014

Take a listen to the podcast to hear a breakdown of the papers and some really helpful clinical context from one of our local EM-Intensivists, Adarsh Srivastava.

Thanks to Josh Denney, MD, Andrew Latimer, MD, and Kyle Nizolek, MD, PGY-3 residents in the University of Cincinnati Dept of EM Residency Training Program for their leadership of the journal club discussion and to the residents and faculty for their vibrant discussion of the topic!