A proposed two-step process combining an ultrasonographic Diamond-Forrester plot with dynamic assessment for fluid responsiveness aims to individualize therapy in hemodynamically unstable patients.
Does a two-step dynamic POCUS assessment using the Diamond-Forrester classification improve individualization of therapy in hemodynamically unstable patients compared to a static approach?
A proposed dynamic two-step POCUS assessment integrating the Diamond-Forrester classification may help clarify fluid responsiveness and tolerance in hemodynamically unstable patients.
Point of care ultrasound (POCUS) is a first-line tool to assess hemodynamically unstable patients, however, there is confusion surrounding intertwined concepts such as: “flow,” “congestion,” “fluid responsiveness (FR),” and “fluid tolerance.” We argue that the Frank–Starling relationship is clarifying because it describes the interplay between “congestion” and “flow” on the x -axis and y -axis, respectively. Nevertheless, a single, simultaneous assessment of congestion and flow via POCUS remains a static approach. To expand this, we propose a two-step process. The first step is to place the patient on an ultrasonographic Diamond–Forrester plot. The second step is a dynamic assessment for FR (e.g., passive leg raise), which individualizes therapy across the arc of critical illness.
Kenny et al. (Fri,) conducted a review in Hemodynamically unstable patients. Two-step process using ultrasonographic Diamond-Forrester plot and dynamic assessment vs. Static approach was evaluated. A proposed two-step process combining an ultrasonographic Diamond-Forrester plot with dynamic assessment for fluid responsiveness aims to individualize therapy in hemodynamically unstable patients.
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