Key result
Integrating point-of-care ultrasound (POCUS) with conventional physical examination provides a more accurate and objective assessment of intravascular volume status than either method alone.
Why the study?
Volume status assessment is subjective, challenging, and prone to provider variation, with traditional non-invasive and invasive methods limited by notable pitfalls and small validation cohorts.
Point-of-care ultrasound (POCUS) is a widely available, non-invasive tool that should be integrated with history and clinical examination to improve the precision of volume status assessment.
May aid fluid decisions in critical care; leaves open need for outcome trials before practice change.
Volume status assessment is a critical but challenging clinical skill and is especially important for the management of patients in the emergency department, intensive care unit, and dialysis unit where accurate intravascular assessment is necessary to guide appropriate fluid management. Assessment of volume status is subjective and can vary from provider to provider, posing clinical dilemmas. Traditional non-invasive methods of volume assessment include assessment of skin turgor, axillary sweat, peripheral edema, pulmonary crackles, orthostatic vital signs, and jugular venous distension. Invasive assessments of volume status include direct measurement of central venous pressure and pulmonary artery pressures. Each of these has their own limitations, challenges, and pitfalls and were often validated based on small cohorts with questionable comparators. In the past 30 years, the increased availability, progressive miniaturization, and falling price of ultrasound devices has made point of care ultrasound (POCUS) widely available. Emerging evidence base and increased uptake across multiple subspecialities has facilitated the adoption of this technology. POCUS is now widely available, relatively inexpensive, free of ionizing radiation, and can help providers make medical decisions with more precision. POCUS is not intended to replace the physical exam, but rather to complement clinical assessment, guiding providers to give thorough and accurate clinical care to their patients. We should be mindful of the nascent literature supporting the use of POCUS and other limitations as uptake increases among providers and be wary not to use POCUS to substitute clinical judgement, but integrate ultrasonographic findings carefully with history and clinical examination.
No takes yet. Share an insight, caveat, or question.
Kearney et al. (2022) conducted a review in Volume status assessment. Point of care ultrasound (POCUS) vs. Conventional physical examination was evaluated. Integrating point-of-care ultrasound (POCUS) with conventional physical examination provides a more accurate and objective assessment of intravascular volume status than either method alone.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: