The use of venous Doppler to predict adverse kidney events in a general ICU cohort

doi:10.1186/s13054-020-03330-6

Observational Study

. 2020 Oct 19;24(1):615.

doi: 10.1186/s13054-020-03330-6.

The use of venous Doppler to predict adverse kidney events in a general ICU cohort

Rory Spiegel^{1

2}, William Teeter^{3

4}, Scott Sullivan⁵, Keegan Tupchong^{6

7}, Nabeel Mohammed⁸, Mark Sutherland⁹, Evan Leibner¹⁰, Philippe Rola¹¹, Samuel M Galvagno Jr¹², Sarah B Murthi¹³

Affiliations

¹ Department of Critical Care, Georgetown University Medstar Washington Hospital Center, Washington, DC, USA.
² Department of Emergency Medicine, Georgetown University Medstar Washington Hospital Center, Washington, DC, USA.
³ Department of Emergency Medicine, R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, MD, USA. william.teeter@som.umaryland.edu.
⁴ Program in Trauma and Surgical Critical Care, R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, MD, USA. william.teeter@som.umaryland.edu.
⁵ The U.S. Army Command and General Staff College, Leavenworth, KS, USA.
⁶ Division of Critical Care, Department of Emergency Medicine, University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA.
⁷ Division of Critical Care, Department of Medicine, University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA.
⁸ Department of Surgical Critical Care, Medstar Washington Hospital Center, Washington, DC, USA.
⁹ Department of Critical Care and Emergency Medicine, University of Maryland Medical Center, Baltimore, MD, USA.
¹⁰ Critical Care Medicine, Department of Emergency Medicine Mount, Sinai Hospital, New York, NY, USA.
¹¹ Intensive Care Unit, Santa Cabrini Hospital, Montreal, Canada.
¹² Department of Anesthesiology, Program in Trauma, R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, MD, USA.
¹³ Program in Trauma and Surgical Critical Care, R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, MD, USA.

PMID: 33076961
PMCID: PMC7574322
DOI: 10.1186/s13054-020-03330-6

Observational Study

The use of venous Doppler to predict adverse kidney events in a general ICU cohort

Rory Spiegel et al. Crit Care. 2020.

. 2020 Oct 19;24(1):615.

doi: 10.1186/s13054-020-03330-6.

Authors

Affiliations

¹ Department of Critical Care, Georgetown University Medstar Washington Hospital Center, Washington, DC, USA.
² Department of Emergency Medicine, Georgetown University Medstar Washington Hospital Center, Washington, DC, USA.
³ Department of Emergency Medicine, R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, MD, USA. william.teeter@som.umaryland.edu.
⁴ Program in Trauma and Surgical Critical Care, R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, MD, USA. william.teeter@som.umaryland.edu.
⁵ The U.S. Army Command and General Staff College, Leavenworth, KS, USA.
⁶ Division of Critical Care, Department of Emergency Medicine, University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA.
⁷ Division of Critical Care, Department of Medicine, University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA.
⁸ Department of Surgical Critical Care, Medstar Washington Hospital Center, Washington, DC, USA.
⁹ Department of Critical Care and Emergency Medicine, University of Maryland Medical Center, Baltimore, MD, USA.
¹⁰ Critical Care Medicine, Department of Emergency Medicine Mount, Sinai Hospital, New York, NY, USA.
¹¹ Intensive Care Unit, Santa Cabrini Hospital, Montreal, Canada.
¹² Department of Anesthesiology, Program in Trauma, R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, MD, USA.
¹³ Program in Trauma and Surgical Critical Care, R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, MD, USA.

PMID: 33076961
PMCID: PMC7574322
DOI: 10.1186/s13054-020-03330-6

Abstract

Background: Changes in Doppler flow patterns of hepatic veins (HV), portal vein (PV) and intra-renal veins (RV) reflect right atrial pressure and venous congestion; the feasibility of obtaining these assessments and the clinical relevance of the findings is unknown in a general ICU population. This study compares the morphology of HV, PV and RV waveform abnormalities in prediction of major adverse kidney events at 30 days (MAKE30) in critically ill patients.

Study design and methods: We conducted a prospective observational study enrolling adult patients within 24 h of admission to the ICU. Patients underwent an ultrasound evaluation of the HV, PV and RV. We compared the rate of MAKE-30 events in patients with and without venous flow abnormalities in the hepatic, portal and intra-renal veins. The HV was considered abnormal if S to D wave reversal was present. The PV was considered abnormal if the portal pulsatility index (PPI) was greater than 30%. We also examined PPI as a continuous variable to assess whether small changes in portal vein flow was a clinically important marker of venous congestion.

Results: From January 2019 to June 2019, we enrolled 114 patients. HV abnormalities demonstrate an odds ratio of 4.0 (95% CI 1.4-11.2). PV as a dichotomous outcome is associated with an increased odds ratio of MAKE-30 but fails to reach statistical significance (OR 2.3 95% CI 0.87-5.96), but when examined as a continuous variable it demonstrates an odds ratio of 1.03 (95% CI 1.00-1.06). RV Doppler flow abnormalities are not associated with an increase in the rate of MAKE-30 INTERPRETATION: Obtaining hepatic, portal and renal venous Doppler assessments in critically ill ICU patients are feasible. Abnormalities in hepatic and portal venous Doppler are associated with an increase in MAKE-30. Further research is needed to determine if venous Doppler assessments can be useful measures in assessing right-sided venous congestion in critically ill patients.

Keywords: Ultrasound; Venous congestion; Venous return.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

**Fig. 1**
Ultrasound surface and B-mode anatomy and normal venous Doppler waveforms

**Fig. 2**
Normal and abnormal venous Doppler waveforms

See this image and copyright information in PMC

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References

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[1] O'Connor ME, Prowle JR. Fluid overload. Crit Care Clin. 2015;31(4):803–821. doi: 10.1016/j.ccc.2015.06.013. - DOI - PubMed

[2] O'Connor ME, Prowle JR. Fluid overload. Crit Care Clin. 2015;31(4):803–821. doi: 10.1016/j.ccc.2015.06.013. - DOI - PubMed

[3] Malbrain M, Van Regenmortel N, Saugel B, et al. Principles of fluid management and stewardship in septic shock: it is time to consider the four D's and the four phases of fluid therapy. Ann Intensive Care. 2018;8(1):66. doi: 10.1186/s13613-018-0402-x. - DOI - PMC - PubMed

[4] Malbrain M, Van Regenmortel N, Saugel B, et al. Principles of fluid management and stewardship in septic shock: it is time to consider the four D's and the four phases of fluid therapy. Ann Intensive Care. 2018;8(1):66. doi: 10.1186/s13613-018-0402-x. - DOI - PMC - PubMed

[5] Rhodes A, Evans LE, Alhazzani W, et al. Surviving sepsis campaign: international guidelines for management of sepsis and septic shock: 2016. Crit Care Med. 2017;45(3):486–552. doi: 10.1097/CCM.0000000000002255. - DOI - PubMed

[6] Rhodes A, Evans LE, Alhazzani W, et al. Surviving sepsis campaign: international guidelines for management of sepsis and septic shock: 2016. Crit Care Med. 2017;45(3):486–552. doi: 10.1097/CCM.0000000000002255. - DOI - PubMed

[7] Mullens W, Abrahams Z, Francis GS, et al. Importance of venous congestion for worsening of renal function in advanced decompensated heart failure. J Am Coll Cardiol. 2009;53(7):589–596. doi: 10.1016/j.jacc.2008.05.068. - DOI - PMC - PubMed

[8] Mullens W, Abrahams Z, Francis GS, et al. Importance of venous congestion for worsening of renal function in advanced decompensated heart failure. J Am Coll Cardiol. 2009;53(7):589–596. doi: 10.1016/j.jacc.2008.05.068. - DOI - PMC - PubMed

[9] Wiedemann HP, et al. Comparison of two fluid-management strategies in acute lung injury. N Engl J Med. 2006;354(24):2564–2575. doi: 10.1056/NEJMoa062200. - DOI - PubMed

[10] Wiedemann HP, et al. Comparison of two fluid-management strategies in acute lung injury. N Engl J Med. 2006;354(24):2564–2575. doi: 10.1056/NEJMoa062200. - DOI - PubMed

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The use of venous Doppler to predict adverse kidney events in a general ICU cohort

Affiliations

The use of venous Doppler to predict adverse kidney events in a general ICU cohort

Authors

Affiliations

Abstract

Conflict of interest statement

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