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Declaration of
Interests
• Too much/little
• Interactions
• Appropriate timing
Drug
• Pharmacokinetics
• Pharmacodynamics
• Toxicity
Dosing
• Appro...
Resuscitation Optimisation Stabilisation
de-
Escalation
POCUS and and fluid
management
A BETTER WAY
@PARADicmSHIFT
Resuscitation Optimisation Stabilisation
de-
Escalation

1
When
to start
fluids
When
to stop
fluids
When
to start fluid
removal
2 3
When
to stop
removal
4
Knowing
when to
STOP
Core
Echocardiography LV function and size
RV function and size
IVC
RV function
Lung
ultrasound
•B-lines yes/no
•Effusions yes/no
Basic
•B-line quantification
Advanced
Misc
Advanced echocardiography
Portal vein pulsatility
Intra-renal Doppler
Tissue
Velocity-Time Integral
Diastology
Summary
Too much fluid is detrimental
Knowing ‘when is too much’ is
crucial
Intergrated, multimodal
POCUS examination can ...
7th
#IFAD2018Reviewing recent advances in fluid
management and haemodynamic
and organ function monitoring in
critical care...
Key
References
 Four phases of intravenous fluid therapy: a conceptual model -
https://academic.oup.com/bja/article/113/5...
Pocus and deresuscitation
Pocus and deresuscitation
Pocus and deresuscitation
Pocus and deresuscitation
Pocus and deresuscitation
Pocus and deresuscitation
Pocus and deresuscitation
Pocus and deresuscitation
Pocus and deresuscitation
Pocus and deresuscitation
Pocus and deresuscitation
Pocus and deresuscitation
Pocus and deresuscitation
Pocus and deresuscitation
Pocus and deresuscitation
Pocus and deresuscitation
Pocus and deresuscitation
Pocus and deresuscitation
Pocus and deresuscitation
Pocus and deresuscitation
Pocus and deresuscitation
Pocus and deresuscitation
Pocus and deresuscitation
Pocus and deresuscitation
Pocus and deresuscitation
Pocus and deresuscitation
Pocus and deresuscitation
Pocus and deresuscitation
Pocus and deresuscitation
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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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