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. 2020 Feb 24:2020:9719751.
doi: 10.1155/2020/9719751. eCollection 2020.

Sonographic Assessment of Intravascular Fluid Estimate (SAFE) Score by Using Bedside Ultrasound in the Intensive Care Unit

Keith Killu  1   2 , Victor Coba  1 , Dionne Blyden  1 , Semeret Munie  3 , Darlene Dereczyk  1 , Pridvi Kandagatla  1 , Amy Tang  4
Affiliations

Sonographic Assessment of Intravascular Fluid Estimate (SAFE) Score by Using Bedside Ultrasound in the Intensive Care Unit

Keith Killu et al. Crit Care Res Pract. .

Abstract

Objective: The objective of the study was to use an ultrasound-based numerical scoring system for assessment of intravascular fluid estimate (SAFE) and test its validity.

Methods: A prospective, observational study was carried out in the surgical intensive care unit (ICU) of an urban tertiary care teaching hospital. Patient's intravascular volume status was assessed using the standard methods of heart rate, blood pressure, central venous pressure, cardiac output, lactate and saturation of venous oxygen, and others. This was compared with assessment using bedside ultrasound evaluation of the cardiac function, inferior vena cava, lungs, and the internal jugular vein. Applying a numerical scoring system was evaluated by Fisher's exact testing and multinomial logistic model to predict the volume status based on ultrasound scores and the classification accuracy.

Results: 61 patients in the ICU were evaluated. 21 (34.4% of total) patients diagnosed with hypovolemia, and their ultrasound volume score was -4 in 14 (66.7%) patients, -3 in 5 (23.8%) patients, and 0 in 2 (9.5%) patients (p < 0.001). 18 (29.5% of total) patients diagnosed with euvolemia, and their ultrasound volume score was 0 in 11 (61.1%) patients, +1 in 4 (22.2%) patients, and -1 in 1 (5.6%) patient (p < 0.001). 18 (29.5% of total) patients diagnosed with euvolemia, and their ultrasound volume score was 0 in 11 (61.1%) patients, +1 in 4 (22.2%) patients, and -1 in 1 (5.6%) patient (p < 0.001). 18 (29.5% of total) patients diagnosed with euvolemia, and their ultrasound volume score was 0 in 11 (61.1%) patients, +1 in 4 (22.2%) patients, and -1 in 1 (5.6%) patient (p < 0.001). 18 (29.5% of total) patients diagnosed with euvolemia, and their ultrasound volume score was 0 in 11 (61.1%) patients, +1 in 4 (22.2%) patients, and -1 in 1 (5.6%) patient (.

Conclusion: Using the SAFE scoring system to identify the IVV status in critically ill patients significantly correlates with the standard measures. A SAFE score of -4 to -2 more likely represents hypovolemia, -1 to +1 more likely represents euvolemia, and +2 to +4 more likely to be hypervolemia.

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Conflict of interest statement

All authors declare they have no conflicts of interest.

Figures

Figure 1
Figure 1
(a) Transducer position on the chest, left parasternal 4-5th intercostal space. (b) Long axis view of the heart. (c) M-mode measuring the ejection fraction (EF).
Figure 2
Figure 2
(a) Lung sectors examined: L1 midclavicular line upper chest, L2 midclavicular line lower chest, L3 midaxillary line upper chest, and L4 midaxillary line lower chest. (b) Transducer positioning. (c) Example B-lines.
Figure 3
Figure 3
Inferior vena cava (IVC) exam. (a) Transducer placement, midline upper abdomen below the xyphoid. (b) B-mode IVC. (c) M-mode IVC measurements during the respiratory cycle.
Figure 4
Figure 4
Internal jugular vein (IJV) exam. (a) Placement of the transducer with least or minimal pressure possible. (b) B-mode IJV. (c) M-mode measurement and variation of the IJV during the respiratory cycle. CCA: common carotid artery.
Figure 5
Figure 5
Fluid status estimation with the standard methods compared with the SAFE score. Fisher's exact test, p value <0.001, indicating impression standard measures which correlate with the final SAFE scores.
See this image and copyright information in PMC

References

    1. The American College of Emergency Physicians. Ultrasound Guidelines: Emergency, Point of Care, and Clinical Ultrasound Guidelines in Medicine. Irving, TX, USA: The American College of Emergency Physicians; 2016. https://www.acep.org/globalassets/new-pdfs/policy-statements/ultrasound-....
    1. Frankel H. L., Kirkpatrick A. W., Elbarbary M., et al. Guidelines for the appropriate use of bedside general and cardiac ultrasonography in the evaluation of critically ill patients-Part I: general ultrasonography. Critical Care Medicine. 2015;43(11):2479–2502. doi: 10.1097/ccm.0000000000001216. - DOI - PubMed
    1. Levitov A., Frankel H. L., Blaivas M., et al. Guidelines for the appropriate use of bedside general and cardiac ultrasonography in the evaluation of critically ill patients-Part II: cardiac ultrasonography. Critical Care Medicine. 2016;44(6):1206–1227. doi: 10.1097/ccm.0000000000001847. - DOI - PubMed
    1. Via G., Hussain A., Wells M., et al. International evidence-based recommendations for focused cardiac ultrasound. Journal of the American Society of Echocardiography. 2014;27(7):683 e1–683 e33. doi: 10.1016/j.echo.2014.05.001. - DOI - PubMed
    1. Mintz G. S., Kotler M. N., Parry W. R., Iskandrian A. S., Kane S. A. Reat-time inferior vena caval ultrasonography: normal and abnormal findings and its use in assessing right-heart function. Circulation. 1981;64(5):1018–1025. doi: 10.1161/01.cir.64.5.1018. - DOI - PubMed

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