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Review
. 2021 Jun 2;2(8):1349-1359.
doi: 10.34067/KID.0002322021. eCollection 2021 Aug 26.

Use of Ultrasound to Assess Hemodynamics in Acutely Ill Patients

Sami Safadi  1 , Sarah Murthi  2 , Kianoush B Kashani  3   4
Affiliations
Review

Use of Ultrasound to Assess Hemodynamics in Acutely Ill Patients

Sami Safadi et al. Kidney360. .

Abstract

Early diagnosis of AKI and preventive measures can likely decrease the severity of the injury and improve patient outcomes. Current hemodynamic monitoring variables, including BP, heart and respiratory rates, temperature, and oxygenation status, have been used to identify patients at high risk for AKI. Despite the widespread use of such variables, their ability to accurately and timely detect patients who are high risk has been questioned. Therefore, there is a critical need to develop and validate tools that can measure new and more kidney-specific hemodynamic and laboratory variables, potentially assisting with AKI risk stratification, implementing appropriate and timely preventive measures, and hopefully improved outcomes. The new ultrasonography techniques provide novel insights into kidney hemodynamics and potential management and/or therapeutic targets. Contrast-enhanced ultrasonography; Doppler flow patterns of hepatic veins, portal vein, and intrakidney veins; and ultrasound elastography are among approaches that may provide such information, particularly related to vascular changes in AKI, venous volume excess or congestion, and fluid tolerance. This review summarizes the current state of these techniques and their relevance to kidney hemodynamic management.

Keywords: AKI; IVF; POCU; acute kidney injury; acute kidney injury and ICU nephrology; hemodynamics; intravenous fluids; kidney congestion; ultrasound; volume overload; volume tolerance.

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Conflict of interest statement

K.B. Kashani reports having consultancy agreements with AM Pharma; serving as a scientific advisor for, or member of, GE, La Jolla Inc., and MediBeacon Inc.; and receiving research funding from La Jolla Inc. All remaining authors have nothing to disclose.

Figures

Figure 1.
Figure 1.
Fluid movement balance across capillary wall and edema formation from increased venous pressure. White arrows indicate blood movement direction, short blue arrows indicate fluid movement across the capillary wall, and long red and blue arrows indicate direction of movement of oxygenated (red arrows) and deoxygenated (blue arrows) blood. Green vessels represent lymphatics.
Figure 2.
Figure 2.
Ultrasound probe placement location to acquire hepatic and portal vein images. IVC, inferior vena cava.
Figure 3.
Figure 3.
Normal and abnormal venous waveforms in hepatic, portal and intrarenal veins. a, atrial contraction; S, systolic flow; D, diastolic flow.
Figure 4.
Figure 4.
Ultrasound probe placement location to obtain kidney Doppler waveforms.
Figure 5.
Figure 5.
Doppler flow patterns for assessment of venous excess ultrasound score (VExUS). RAP, right atrial pressure.
Figure 6.
Figure 6.
Echocardiographic windows used to acquire cardiac images. (A) parasternal long-axis (PLAX) view; (B) parasternal short-axis (PSAX) view; and (C) apical four-chamber (A4C) and apical five-chamber (A5C) views. AV, aortic valve; LA, left atrium; LV, left ventricle; LVOT, left ventricular outflow tract; RA, right atrium; RV, right ventricle.
Figure 7.
Figure 7.
Ultrasonography examination for Case 1. (A) Hepatic vein, (B) portal vein, and (C) intrakidney Doppler waveforms.
Figure 8.
Figure 8.
Ultrasonography examination for Case 2. (A) Hepatic vein, (B) portal vein, and (C) intrakidney Doppler waveforms.
See this image and copyright information in PMC

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