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. 2024 Nov 1;14(1):167.
doi: 10.1186/s13613-024-01391-2.

Changes in portal pulsatility index induced by a fluid challenge in patients with haemodynamic instability and systemic venous congestion: a prospective cohort study

Martin Ruste  1   2   3 , Rehane Reskot  4 , Rémi Schweizer  4   5 , Valentin Mayet  4 , Jean-Luc Fellahi  4   5   6 , Matthias Jacquet-Lagrèze  4   5   6
Affiliations

Changes in portal pulsatility index induced by a fluid challenge in patients with haemodynamic instability and systemic venous congestion: a prospective cohort study

Martin Ruste et al. Ann Intensive Care. .

Abstract

Background: It is uncertain whether fluid administration can improve patients with systemic venous congestion and haemodynamic instability. This study aimed to describe the changes in systemic venous congestion and peripheral perfusion parameters induced by a fluid challenge in these patients, and to analyse the influence of the fluid responsiveness status on these changes.

Methods: The study is a single-centre prospective cohort study of 36 critically ill ICU patients with haemodynamic instability and a maximum vena cava diameter ≥ 20 mm. Changes in cardiac index during a fluid challenge (4 mL/kg of lactated Ringer's solution during 5 min) assessed by pulse contour analysis, central venous pressure, ultrasound systemic congestion parameters (portal venous flow pulsatility index, supra hepatic and intrarenal venous Doppler), and peripheral perfusion parameters (capillary refill time and peripheral perfusion index) were assessed in the overall population. All these data were compared between patients presenting a cardiac index increase > 10% during the fluid challenge (fluid responders) and the others (fluid non-responders).

Results: Twenty-eight (78%) patients were admitted for postoperative care following cardiac surgery; their mean ± SD left ventricular ejection fraction was 42 ± 9% and right ventricular dysfunction was found in at least 61% of the patients. The mean ± SD SOFA score was 9 ± 3. Thirteen (36%) patients were fluid responders. The fluid challenge administration induced a significant increase in portal pulsatility index, VExUS score, and central venous pressure without significant difference of these changes between fluid responders and non-responders. No significant change in perfusion parameters was observed.

Conclusion: Fluid administration in patients with haemodynamic instability and systemic venous congestion worsens venous congestion regardless of the fluid responsiveness status, without improving perfusion parameters.

Keywords: Haemodynamic instability; Portal pulsatility index; Preload responsiveness; Systemic venous congestion; Ultrasound.

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Conflict of interest statement

The authors have no conflicts of interest related to the study to declare.

Figures

Fig. 1
Fig. 1
Variations of the cardiac index, portal pulsatility index, central venous pressure, and capillary refill time parameters during the fluid challenge. Left column: fluid responders. Right column: fluid non-responders. CI: cardiac index; CRT: capillary refill time; CVP: central venous pressure; FC: fluid challenge; PP: portal pulsatility index; *P value < 0.05 for Wilcoxon signed-ranked test for the comparison between before and after fluid challenge
Fig. 2
Fig. 2
Correlation matrix to explore the relationship between the changes in haemodynamic, perfusion, and ultrasound estimated systemic venous congestion parameters during the fluid challenge. Numerical values correspond to Spearman’s rank correlation coefficient
See this image and copyright information in PMC

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