Tags

Type your tag names separated by a space and hit enter

Changes in cardiac output with hemodialysis relate to net volume balance and to inferior vena cava ultrasound collapsibility in critically ill patients.
Ren Fail. 2020 Nov; 42(1):179-192.RF

Abstract

Cardiac output may increase after volume administration with relative intravascular volume depletion, or after ultrafiltration (UF) with relative intravascular volume overload. Assessing relative intravascular volume using respiratory/ventilatory changes in inferior vena cava (IVC) diameters may guide volume management to optimize cardiac output in critically ill patients requiring hemodialysis (HD) and/or UF.We retrospectively studied 22 critically ill patients having relative intravascular volume assessed by IVC Collapsibility Index (IVC CI) = (IVCmax-IVCmin)/IVCmax*100%, within 24 h of cardiac output measurement, during 37 intermittent and 21 continuous HD encounters. Cardiac output increase >10% was considered significant. Net volume changes between cardiac outputs were estimated from "isonatremic volume equivalent" (0.9% saline) gains and losses.Cardiac output increased >10% in 15 of 42 encounters with IVC CI <20% after net volume removal, and in 1 of 16 encounters with IVC CI ≥20% after net volume administration (p = 0.0136). All intermittent and continuous HD encounters resulted in intradialytic hypotension. Net volume changes between cardiac output measurements were significantly less (median +1.0 mL/kg) with intractable hypotension or vasopressor initiation, and net volume removal was larger (median -22.9 mL/kg) with less severe intradialytic hypotension (p < 0.001). Cardiac output increased >10% more frequently with least severe intradialytic hypotension and decreased with most severe intradialytic hypotension (p = 0.047).In summary, cardiac output may increase with net volume removal by ultrafiltration in some critically ill patients with relative intravascular volume overload assessed by IVC collapsibility. Severe intradialytic hypotension may limit volume removal with ultrafiltration, rather than larger volume removal causing severe intradialytic hypotension.

Authors+Show Affiliations

Department of Medicine, Division of Nephrology, Loma Linda University Medical Center, Loma Linda, CA, USA. Department of Medicine, Division of Nephrology, University of Southern California, Los Angeles, CA, USA.Department of Medicine, Division of Nephrology, University of Southern California, Los Angeles, CA, USA.Department of Medicine, Division of Nephrology, University of Southern California, Los Angeles, CA, USA.Department of Medicine, Division of Nephrology, University of Southern California, Los Angeles, CA, USA.Department of Medicine, Division of Nephrology, University of Southern California, Los Angeles, CA, USA.Department of Medicine, Division of Nephrology, University of Southern California, Los Angeles, CA, USA.Department of Medicine, Division of Nephrology, University of Southern California, Los Angeles, CA, USA.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

32050836

Citation

Kaptein, Matthew J., et al. "Changes in Cardiac Output With Hemodialysis Relate to Net Volume Balance and to Inferior Vena Cava Ultrasound Collapsibility in Critically Ill Patients." Renal Failure, vol. 42, no. 1, 2020, pp. 179-192.
Kaptein MJ, Kaptein JS, Nguyen CD, et al. Changes in cardiac output with hemodialysis relate to net volume balance and to inferior vena cava ultrasound collapsibility in critically ill patients. Ren Fail. 2020;42(1):179-192.
Kaptein, M. J., Kaptein, J. S., Nguyen, C. D., Oo, Z., Thwe, P. P., Thu, M. B., & Kaptein, E. M. (2020). Changes in cardiac output with hemodialysis relate to net volume balance and to inferior vena cava ultrasound collapsibility in critically ill patients. Renal Failure, 42(1), 179-192. https://doi.org/10.1080/0886022X.2020.1726384
Kaptein MJ, et al. Changes in Cardiac Output With Hemodialysis Relate to Net Volume Balance and to Inferior Vena Cava Ultrasound Collapsibility in Critically Ill Patients. Ren Fail. 2020;42(1):179-192. PubMed PMID: 32050836.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Changes in cardiac output with hemodialysis relate to net volume balance and to inferior vena cava ultrasound collapsibility in critically ill patients. AU - Kaptein,Matthew J, AU - Kaptein,John S, AU - Nguyen,Christopher D, AU - Oo,Zayar, AU - Thwe,Phyu Phyu, AU - Thu,Myint Bo, AU - Kaptein,Elaine M, PY - 2020/2/14/entrez PY - 2020/2/14/pubmed PY - 2020/2/14/medline KW - Cardiac output KW - Intravascular volume KW - inferior vena cava ultrasound KW - intradialytic hypotension KW - renal replacement therapy KW - ultrafiltration SP - 179 EP - 192 JF - Renal failure JO - Ren Fail VL - 42 IS - 1 N2 - Cardiac output may increase after volume administration with relative intravascular volume depletion, or after ultrafiltration (UF) with relative intravascular volume overload. Assessing relative intravascular volume using respiratory/ventilatory changes in inferior vena cava (IVC) diameters may guide volume management to optimize cardiac output in critically ill patients requiring hemodialysis (HD) and/or UF.We retrospectively studied 22 critically ill patients having relative intravascular volume assessed by IVC Collapsibility Index (IVC CI) = (IVCmax-IVCmin)/IVCmax*100%, within 24 h of cardiac output measurement, during 37 intermittent and 21 continuous HD encounters. Cardiac output increase >10% was considered significant. Net volume changes between cardiac outputs were estimated from "isonatremic volume equivalent" (0.9% saline) gains and losses.Cardiac output increased >10% in 15 of 42 encounters with IVC CI <20% after net volume removal, and in 1 of 16 encounters with IVC CI ≥20% after net volume administration (p = 0.0136). All intermittent and continuous HD encounters resulted in intradialytic hypotension. Net volume changes between cardiac output measurements were significantly less (median +1.0 mL/kg) with intractable hypotension or vasopressor initiation, and net volume removal was larger (median -22.9 mL/kg) with less severe intradialytic hypotension (p < 0.001). Cardiac output increased >10% more frequently with least severe intradialytic hypotension and decreased with most severe intradialytic hypotension (p = 0.047).In summary, cardiac output may increase with net volume removal by ultrafiltration in some critically ill patients with relative intravascular volume overload assessed by IVC collapsibility. Severe intradialytic hypotension may limit volume removal with ultrafiltration, rather than larger volume removal causing severe intradialytic hypotension. SN - 1525-6049 UR - https://www.unboundmedicine.com/medline/citation/32050836/Changes_in_cardiac_output_with_hemodialysis_relate_to_net_volume_balance_and_to_inferior_vena_cava_ultrasound_collapsibility_in_critically_ill_patients_ L2 - http://www.tandfonline.com/doi/full/10.1080/0886022X.2020.1726384 DB - PRIME DP - Unbound Medicine ER -
Try the Free App:
Prime PubMed app for iOS iPhone iPad
Prime PubMed app for Android
Prime PubMed is provided
free to individuals by:
Unbound Medicine.