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Pocus and deresuscitation

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Part of the joint International Fluid Academy and World Society of Abdominal Compartment Syndrome workshop at the Emirates Critical Car Conference 2018

Published in: Health & Medicine
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Pocus and deresuscitation

  1. 1. Declaration of Interests
  2. 2. • Too much/little • Interactions • Appropriate timing Drug • Pharmacokinetics • Pharmacodynamics • Toxicity Dosing • Appropriate duration • Treat until responseDuration • MonitoringDe-escalation
  3. 3. Resuscitation Optimisation Stabilisation de- Escalation
  4. 4. POCUS and and fluid management A BETTER WAY
  5. 5. @PARADicmSHIFT
  6. 6. Resuscitation Optimisation Stabilisation de- Escalation
  7. 7.  1 When to start fluids When to stop fluids When to start fluid removal 2 3 When to stop removal 4
  8. 8. Knowing when to STOP
  9. 9. Core Echocardiography LV function and size RV function and size IVC
  10. 10. RV function
  11. 11. Lung ultrasound •B-lines yes/no •Effusions yes/no Basic •B-line quantification Advanced
  12. 12. Misc Advanced echocardiography Portal vein pulsatility Intra-renal Doppler Tissue
  13. 13. Velocity-Time Integral
  14. 14. Diastology
  15. 15. Summary Too much fluid is detrimental Knowing ‘when is too much’ is crucial Intergrated, multimodal POCUS examination can aid decisions at all stages
  16. 16. 7th #IFAD2018Reviewing recent advances in fluid management and haemodynamic and organ function monitoring in critical care All specialties welcome! @Fluid_Academy www.fluidacademy.org International FluidAcademy Day The Netherlands Amsterdam
  17. 17. Key References  Four phases of intravenous fluid therapy: a conceptual model - https://academic.oup.com/bja/article/113/5/740/2920186  Transthoracic echocardiography: an accurate and precise method for estimating cardiac output in the critically ill patient - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5465531/  www.Thinkingcriticalcare.com  Development of a fluid resuscitation protocol using inferior vena cava and lung ultrasound - https://www.ncbi.nlm.nih.gov/pubmed/26475100  Diastolic dysfunction in anaesthesia and critical care - https://academic.oup.com/bjaed/article/16/9/287/1743688  IntrarenalVenous Flow:AWindow Into the Congestive Kidney Failure Phenotype of Heart Failure? - http://heartfailure.onlinejacc.org/content/jhf/4/8/683.full.pdf

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