The following is a summary of “Incidence, predictability, and outcomes of systemic venous congestion following a fluid challenge in initially fluid-tolerant preload-responders after cardiac surgery: a pilot trial,” published in the October 2024 issue of Critical Care by Morosanu et al.  

Fluid administration usually emphasizes preload responsiveness (PR). However, preventing fluid intolerance caused by systemic venous congestion (VC) is also crucial.   

Researchers conducted a prospective study analyzing how often VC occurs after a 7 ml/kg crystalloid infusion in fluid-tolerant preload responders and its link to adverse outcomes.   

They conducted a single-center observational study from May 2023 to July 2024 involving 40 patients on mechanical ventilation within 6 hours of ICU admission after open-heart surgery with acute circulatory failure. Patients were eligible if they were fluid-tolerant and preload-responsive. PR was defined as a >12% increase in left-ventricular outflow tract velocity time integral (LVOT-VTI) 1 min after a passive leg raising (PLR) test. Patients received a 7 ml/kg Ringer’s Lactate infusion, and outcomes included early VC (incidence of VC 2-min post-infusion) and acute kidney injury (AKI) within a week and ICU length of stay (LOS).   

The results showed that Early VC occurred in 45% of patients, but only 5% still had VC at 20 minutes. Almost one-third experienced AKI, with 17.5% progressing to severe AKI. The median IC length of stay was 4 days. Patients with early VC had higher central venous pressure, lower mean perfusion pressure, poorer baseline right ventricular function, and more severe AKI. While LVOT-VTI returned to baseline by 20 minutes, PVPI remained elevated in patients with early VC (P<0.001). Post-passive leg raising PVPI effectively predicted early VC with an area under the curve of 0.998 at a threshold of 44.3% (P<0.001).  

Investigators concluded that post-passive leg raising PVPI is a reliable predictor of fluid-induced early venous congestion in fluid-tolerant preload responders. It can help identify patients with poor right ventricular diastolic reserve and improve fluid management in cardiac surgery.  

Source: ccforum.biomedcentral.com/articles/10.1186/s13054-024-05124-6