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The following is a summary of “Changes in portal pulsatility index induced by a fluid challenge in patients with haemodynamic instability and systemic venous congestion: a prospective cohort study,” published in the November 2024 issue of Critical Care by Ruste et al. 

Researchers conducted a retrospective study to describe the changes in systemic venous congestion and peripheral perfusion parameters induced by a fluid challenge and to analyze the influence of fluid responsiveness status on the changes.  

They examined 36 critically ill patients in the ICU with hemodynamic instability and vena cava diameter ≥20 mm. Changes in cardiac index, central venous pressure, ultrasound parameters (portal venous flow pulsatility index, supra hepatic and intrarenal venous Doppler), and peripheral perfusion parameters (capillary refill time, peripheral perfusion index) were assessed during a 4 mL/kg fluid challenge and were compared between fluid responders (cardiac index increase >10%) and non-responders.  

The results showed that 78% of the 28 patients were admitted to post-cardiac surgery with an average left ventricular ejection fraction of 42 ± 9% and at least 61% exhibiting right ventricular dysfunction. The average SOFA score was 9 ± 3. Fluid responsiveness was observed in 36% of the patients. Fluid challenge significantly increased portal pulsatility index, VExUS score, and central venous pressure, with no significant difference between responders and non-responders with constant perfusion parameters.   

Investigators concluded that fluid administration in hemodynamically unstable patients with venous congestion worsened congestion without improving perfusion, regardless of fluid responsiveness. 

Sources: annalsofintensivecare.springeropen.com/articles/10.1186/s13613-024-01391-2