SCCM Resource Library-Hypervolemia in the ICU: A Novel Approach to Fluid Management

Video Transcription

Good morning. Today, actually, we're just going to talk about the hypervolumia, particularly in the ICU setting. And feel free, if you have any questions, just interrupt me. So  if you look at it, we're going to talk about the hypervolumia, particularly in the cardiovascular  surgery patient, in patient who has the cardiorenal syndromes. We're going to talk about these  aquadex, so it's a new device for as therapy for ultrafiltration. We're going to see what's the clinical evidence for it. And then we're going to have some product overview, and at  the end is a QA. If you look at the volume overload on the surgical patient, fluid overload has a strong correlation with the length of the stay in the ICU. There's a nice paper,  as you see it is published by Stein. You're looking at it, just look at the hypervolumic patient, and then those who has a hypervolumia and have an acute kidney disease. Definition  of the acute kidney disease is rising of the creatinine more than 0.6 on this particular study. Then you want to look at the survivor and the non-survivor. If you see the black,  you see a series of the black square and black circle. Black circle is these non-survival just who had a hypervolumia, and then black square is a non-survival who has a hypervolumia  and the AKI. And the white circle and the square is the same thing. Those who has a hypervolumia, they survive, and then the square is those who has a hypervolumia who  survive and they have AKI. So if you look at this, the nicely designed study is a progressive fluid overload after the cardiac surgery may be an earlier and more sensitive marker of  the renal dysfunction, that's serum creatinine. So as the entity has a hypervolumia can determine  which patient is going to develop as far as a survival. What else we know in the cardiac surgery patient? Moreover, this part D, he published a paper I think if I remember 2008.  Not only this hypervolumia is going to show us the length of the stay in the ICU, by itself  as an entity is as an indicator of the survival. If you look at it on the y-axis is the predict  probability of the mortality, and then it's going to be an intravenous volume per liters that the patient has it. If you see it, those just as an entity of the hypervolumic patient  in cardiac surgery, it has an effect as far as a survival. What else we know? This study was published in Canada. It's a multi-center study. They're looking at it. So not only  the hypervolumia is going to show us the length of the stay in the ICU, it's going to show  us those who was going to have a higher mortality. If you see the third most common cause of the readmission, the first 30 days, and then when you expand the idea between the 30 to  90 days, that's the first cause of the readmission. So on the right slide, as you say, the first  line is going to be a rate of the readmission. So in cardiac surgery, because we give a massive  amount of the volume, we had the early experience that the hypervolumia as itself is an entity  not only increase the length of the stay in the ICU, it's going to increase the mortality. And then we have a good valid evidence that when you look at the, as far as the quality  metrics is one of the important cause of the readmission. So let's see what we know about the hypervolumia, particularly last 10 years or so. We try to  emphasize about the pathogenesis of these kidney failure.  So let me conclude this one before I get to that one. So in cardiac surgery patient, I'm sorry,  it's hypervolumia. Those are the fact. And the changing of the serum creatinine has shown  a significant and independent associated with the combined events of death, infection, bleeding,  arrhythmia, pulmonary edema. And then we know that the early identification of the fluid overload  is essential to establish adequate management in cardiac patient. So shifted over on the  last 10 years, which we know about the pathogenesis of the AKI in the cardiorenal patient. That's a nice study. If you're looking at it, venous congestion, which is defined by  the CBP is the most important hemodynamic factor during worsening renal function.  So it's important to know it. If you look at the area under the curve, that if you see for  the sensitivity of it, the creatinine by itself is the red line and the green line is a cardiac index.  So if the impression is on the, you know, cardiorenal patient, lowering of the cardiac output can cause worsening of the renal failure. This study actually nicely has been shown.  Venous congestion by itself, which might be related to the hypervolumia in more than 90%  of the time is a much more sensitive index. And we know that particularly in cardiorenal patient.  What else we know? We know it. If you see it now, we've got a broad spectrum and then look at those  who have a cardiovascular disease. If you look at it, increased central venous pressure is  associated with impaired renal function and all cause mortality. The same concept, which I told  you about the cardiac surgery, which we picked up a long time ago, because we see the massive group  of the patient with the, you know, short period of the time, they get huge amount of the volume.  It has been proven in the cardiorenal and this expanding it almost all category of the cardiovascular  disease. Moreover, is this a study, actually, if you're looking at it, they look at the  intra-abdominal pressure, those who has a heart failure. If we be able to bring the intra-abdominal  pressure by the either diuresis the patient or give a vasodilator, the chance of the recovering  of the kidney function is going to get improved. What you see on the left side is slided. The more  you have a venous congestion, the more amounts of the kidney function deterioration. However, when they start to do to the diuresis the patient or in this particular study,  or give a vasodilator, the renal function has been improved. So, it's cause, actually, I try to generate this slide. From long time ago, at least,  there's a colleague of us, we thinking it, is it this, we know it, even you have an acute kidney  injury with the new definition, may cause to go to the become hypervolemic. But the whole idea is,  does the hypervolemia by itself can cause to beget more acute kidney injury? And then we have a good  data is out nowadays by the monitoring of the CVP and probably I have seen it almost every year is  some publication. So, instead to look at the kidney function as a general, to see is the forward flow,  because I calling it, you know, unfortunately, is this concept we had as a physician, we call it  plumbing. We thought the, you know, flow is going to get down to the kidney and the kidney is going  to be failed, which actually this hypothesis is refuted strongly. So, what do we know, not only  the forward pressure is important, backward pressure as far as the function of the kidney is very important. And then one of the most common cause, those who have a heart disease,  if you look at it, this cause is the hypervolemia. All right, traditionally, if you see, if the patient is hypervolemic, what we do? So, that we had a tool is a Lasix or diuretics,  as generally speaking, potent loop of Henle diuretics. But if you see, by the time we figured out the last stage of the question has been unanswered. For example, we know 40%  of the heart failure patient have a poor diuretic response. It's a huge group of the population.  Just we knew that, why we knew that in cardiac surgery patient, because when the patient goes  on the heart lung machine, we induce cardiogenic shock on them. And when they come out of the  operating room, we give them tons of the volume. We didn't see adequate response with the diuretics.  Second thing is this, is a lots of the question between the clinician is there, that how do we  define diuretic failure? So, it's not the unified approach. Most of the time, we started a little  bit low dose, then we increased the dosage. If it doesn't respond, then sometimes we started drip,  then we have an additive. And it sees a series of the papers out in the wider spectrum from,  doesn't make any difference between you give it infusion, or used to be when I was a fellow,  used to be a bible that everybody is going to come, you're going to give a Lasix infusion, because you get a better diuretic response. But the question that everybody knows,  do we have a maximum dose of the diuretics? We are not sure. Second one, do we measure amount of the total fluid removal? What's the adequate? If the patient already get 150 cc per  hour, what meaning of the urine output is going to be that particular patient is on multiple pressures  and the volume removal is going to mean for them? Do we measure 24 hours urine output? If you look at that hypervolumia, and the idea is you catch it at the end of the 24 hours,  we lost a good amount of the time to get the desirable effect. And then the last one is, do we measure frequency of the administration and the response to the previous treatment?  Most of the time, if you see as experience, we started with, you know, we have nowadays in the  heart failure, several study has been shown, doubling the dosage of the Lasix probably is  the better response, but it's not a unified approach. You give a double the dose of the Lasix,  for how long you're going to monitor how much urine output? So, and usually we're going to lose this  time lead bias that we have. Another concept actually has been evolving is going to be potential causes for that diuretic as a main tool that we have it, why we have this failure.  Does it's a non-compliance, particularly on the setting of the patient as an outpatient is a huge  issue? Is it drug not reaching the kidney is going to be a non-adherence? What's the percentage of  the Lasix is going to be a bonded with the albumin, nutritional status of the patient?  Is it a dose or the frequency is going to be a compliance of the patient? How many tablets of the Lasix, for example, can take it? And then is the poor absorption of this,  as I told you on this, usually if you see a congestive heart failure patient, if they go on the long-term, they don't have a great absorption because of the mucosal edema.  Another concept is important, particularly from the Mayo group that they come with this whole  Lasix stress test. So as you may know, this Lasix is going to go on secreted to the proximal tubules.  So if the idea is most of the pathology of the AKI nowadays through the single nephron theory  and those things we're working on it is on the proximal tubule and the Lasix is going to be secreted, we have already the pathology, our medication does not get there. So if you see  the whole promise of the Lasix challenge test, you give a healthy dose of the Lasix, wider definitions are 140. And then what you can see it, you can look at it within the  response of the kidney for the urine output, and you can determine the outcome of the AKI.  But this practice, I'm pretty sure all of you have seen it. When you give a good dose of the Lasix,  not necessarily you're going to get the desirable effect. Other things that is important is decreased  kidney blood flow, decreased functional kidney mass, all of those is going to happen. Insufficiency  of the kidney response to the drug because a low GFR. And another concept is important,  the heart patient. When you say by definition, if you see it on the congestive heart failure means  intravascular volume is down, but total body, we call it effective intravascular volume is low,  but the total body water is high. So it means if the Lasix is going to look at the blood flow and  the intravascular volume, how are we going to address the extravascular volume, which is most  of the problem. So now we have it, personally, I have experienced a little bit more than 10 years  that you mentioned with the Aquadex, but we use it routinely last 10 years. So what is the  Aquadex flow? It's a form of the ultrafiltration. It's a simplified form of the ultrafiltration.  What it means, it removes all isotonic plasma water. So it means it removes mostly of the water and some of the electrolytes. So that's one. The second is a safe mode to achieve the  uvulemia, precise control and rate and amount of the fluid removal. What it means, it means the  patient come after we use this one is not to see what's the response of the patient, like with the  diuretics. This one very easily, I'm going to show it, you can dial the amount of the free water that  you wanted to remove on the patient on the time base. Let's say you want to remove a 200 per hour.  Within five hours, you're going to be a one liter total fluid removal. So instead, this whole  concept of the prediction is very reliable method of the volume removal or free water removal.  Easy to use it, highly automated setup and operation with only one setting, believe it or  not, when you hook it, you just need to dial. If you're doing the wrong person, if you ask the  nurse, just increase it to 200. It's a matter of less than a few seconds, honestly, as you dial it up.  So it's easy to use. It can be accessed, I'm going to get to this part, prefrontal and the central.  It's going to be a prescriber. You don't need a nephrologist because the principle of the  filtration that we're doing it or the dial as the two different principle is a lot of the base of  the physiology we have to know. On this method, as a matter of fact, you're just going to remove the free water. And then there's a couple of points I'm going to mention it shortly.  Use as far as the nursing, I hope that we have one of the machine, but you can see it on the boot. We have a patient when you do it, honestly, they can walk with it in the ICU.  Having said that, if they use it on their step down, patient can be movable with it. And the nursing ratio is a four to one. And patient, as I said, is ambulate during.  So what's the indication that got the approval? If I remember correctly, 2002 has been in the market or 2003. Can be used temporary for a patient with a volume overload  and have failed diuretic therapy. So you give a diuretics, we don't get a response and you want  to remove the volume. We did it several times. Particularly, let's say, good example of the  patient has a dissection, massive amount of the transfusion has happened. Sometime I remove it  within as soon as the patient, they come and the kidney response is not great. Within the first  eight hours after the surgery, we start to remove the volume. And I tell you why this method is  going to be helpful. We can use it extended time. Those people who are, you know, a friend of mine  just is telling me he's working in the ECMO CT surgery. For those people, let's say on the ECMO  massively resuscitated. As long as the line is there instead to see and patient is stabilized  with the hope is going to be stabilized and then you remove the volume, we are very aggressive  because of that time frame I told you. So we can be extended time. And I personally, I use it more  than four days. The filter time on the machine company recommendation is 92 hours. But you remove  the constant in the volume to catch the multiple pressures and high maintenance the patient is  getting. So how the different society has been using, if you see the idea was first the American  College of Cardiology, American Heart Association, they use the ultrafiltration during the between  2002 and then 2008, 9 was, then is a heart failure society if you see it. So the first  two society, they recommended then the diuretic phase. But if you see the heart failure society,  ultrafiltration may be considered in lieu of the diuretics. It means you give a diuretics  to the patient. But at the same time, you have to remove more volume. So their recommendation  can you add it together, particularly in heart failure society, if you see their guideline,  when you have an RV failure, right ventricular failure, then other society, European society,  and then Canadian cardiovascular society. So those are the starting recommendation. But the usage,  as I said, is too important factor. Not you just need to be lazy, naive, quote unquote, or non-responsive to think about the aqua freezes.  So what's the clinical evidence for it is a series of the study has been highlighted. But just getting the last one was the avoid trial, which the objective was to get it to 800  patients. But they stopped the study at the 200 because the response didn't want it to you know, support the whole study because it's some of the  internal issue that a company that they have. But if you see it, what we know in the cardiac surgery, most of the ultrafiltration reduced duration of the assist ventilation post-op  cardiac surgery, we know that we know combined conventional and modify is the safe in the adult.  I know you wanted to expand it to see to see if the pediatric people they're going to use it or  not. Ultrafiltration improved cardiac performance. Because if you have RV dysfunction, by removing  the volume, you are going to have a better performance of the right side. And then lots of the case nowadays, complicated case, RV failure can cause LV failure. So by improving,  removing the volume, then we have a better, you know, RV function and therefore better LV function.  And then ultrafiltration after cardiac surgery may reduce the need for the blood transfusion. Because nowadays, as those who work in the CT surgery, they know the  transfusion is a quality metrics after the index cases. But go back to the  study of the ABOI trial. I told you they did around 200 patients. I think what if you read  the detail of the patient, the whole design of this study was not to see how this aqua frizzes  helping those patients admitted to the hospital. The idea was to compare it with the diuretics to see how long they are going to be free from any symptom of the heart failure.  So the two different principles have been tried in this study. So if you see it is the on the y-axis percentage of the patient free of the heart failure event.  And on the on the time, the bottom one is the time of the heart failure event. If you see I have a significant difference, it means till 90 days, if a patient remove the volume,  the symptom of the heart failure within 90 days is roughly is around 48 to 53% rest.  Which is amazing data that's came up.  So what about the product overview? Product has a console,  very small machine that hopefully you can see it in the boot.  Then you need access, we're going to talk about it, and then the blood circuit set. So let's about first talk about the console, then is a lot blood set and the access.  So it is important to say, because there's removed the isotonic volume,  so if you see it, it doesn't need like a CBVH when you're running it, and then you check the  panel quite often. Honestly, once a day is quite for the electrolyte is enough, which we do it as  a routinely. And then it has been shown to have a no significant effect on the heart failure.  It has been shown to have a no significant change, and I get to that part why. Reduction of the  neurohormonal stimulation is stabilized to improve the cardiac hemodynamic, restore diuretic effectiveness, and 53% reduction of the risk of the re-hospitalization for heart  failure, which I mentioned to you. So let's see if we can run this animation.  So if you see, it has a rotary pump, it's going to through the venous access, that red line, the blood is going to go all the way to the filter. And then through the filter, through  the another rotary pump that you have, the ultrafiltrate is going to come out. At any given time, blood volume outside of the body is around 33 milliliters, is important.  And if you see on the principle of it, so when the molecule of the water actually get out,  some of this electrolyte is going to get out. So it's a dragging force that is going to go. So it's a simple method that is going to be through this venous access and remove this  isotonic volume. The slide is a little bit crowded, but the main point, if you look, compare it, the CVVH, or the  continuous renal replacement therapy, which is on the right side compared to the aqua friezes,  is that the four major, I think, honestly, it's a few more, but the four major difference.  One is the flow rate. So the flow rate is the flow rate of the blood. So the flow rate of the  I think, honestly, it's a few more, but the four major difference. One is the flow rate.  If you usually, usually the CVVH, my understanding, most of the people, they use it around 180. That's the magic number. You can come down on the machine  to as low as 120, chance of the thrombosis and the machine alarming is significantly higher.  But this machine is going to use it between 20 to 40. So hemodynamic effect of it is significantly  less. Particularly, those of you who does the CVVH, you know, that if I, let's say on time zero to one, I give a two antibiotics to the patient with a volume of 400.  And I wanted the patient to be a net 100 CC negative. It's been the next hour. I'm going  to remove at 550 or 500 to get that achievement. Removing that much of the volume and period of  one hour patient become hypotensive, especially if you want to remove the net negative.  This one, the second one is blood volume, as I tell you, is around 35. So if you lose the  cartilage, so the CVVH, a good amount of the blood, especially those on this patient who are on the TAH, total artificial heart, or ECMO, if you want to prevent on the transfusion,  each clotting of the circuit on the CVVH, you're going to lose good amount of the volume. This  machine is significantly less. Venous access can be done preferably compared to the CVVH.  And then this is a prescriber, which is important. You don't need in the middle of the night. If you want to start it, you got right away, you can go ahead.  All right. About the venous access, all the Shiley catheter that you have, or use it for the HD catheter, this machine can use it. But the minimum that you need is a 216  lines. So if you have a central, you can get the dual CV, no central venous access with 14 gauge.  You can have a dual with the 16 gauge. And if you see the company is actually making these  dual lumen extended length catheter, which the length of it is around 15, if I be correct. And then, uh, we, they have a coil and can be inserted the peripherally either  brachial if somebody has a good size brachial or can be put it on the basalic vein.  Uh, what is not recommended, definitely cannot use on the peak line because the resistance is too  high. Secondly, if you have an angio cat and the size is, let's say 18 for sure is not working,  but we have been creative during this process of the CVVH. If you look at the introducer of the  swan gas or the cord is that you're giving it, it has a decent size lumen. We can get it through  the venous line and return it back to the size of the 16. So some of those patients accurately, they come out of the operating room and they, let's say massively hypervolemic.  Uh, then we did that and has been successful, believe it or not, in matter of, I remember a few years back, I had a patient with these young lady with the, uh, uh, aortic dissection  came out was roughly is around 20% of her body was a morbidly obese patient over the, her actual  base. The volume was high, did not have a great access. We just started with the aqua freezes  right away. As soon as the patient came out of the war, by 24 hours, we were able to patient  keep it around the liter and half negative. And the second day we continue with that. So it means  you can be a creative and we have been in, but that is going to be usage of the size 16, minimum of the 16 and can be a peripherally inserted. Then it's going to come to the  question as far as the anticoagulation, uh, our patient in CT surgery exclusively, we don't use  the, uh, anticoagulation. Why is that? Because we put a bigger, uh, Shiley character. So the larger  the lumen, shorter duration depends on the, how much anticoagulation you need. But definitely if  it's somebody be a post-op day, let's say day seven or somebody on the floor that you want to  started through the peripherally inserted catheter is advised to put the anticoagulation.  Is it need to be a certain number to follow? My experience say no, because we, when we do that on  the ECMO patient, we are going to see a different ACT and as how's our catheter is working. Honestly,  personally, I can tell you last 10 years, if I had a CHF solution, if it'd be clogged off,  most of the time, something wrong with the line either is kinking or you have a clot in the line  is performed. Machine by itself rarely needs anticoagulation, but I'm talking immediately  post-open heart. But if you get a long-term as a peripherally inserted, definitely need for the  life span of this, uh, extended life span of the filter, you need, uh, anticoagulation. Then, uh, is a new feature of this one is coming out. So the method is you can put it on the,  you know, is it like a pulse oximetry as can estimated the, uh, crit. So the idea is when we  remove the free water, let's say if I started with the crit of the 25 and you remove the volume,  assumption is the crit is going to go up. So what this machine can adjust is this crit level that  you're desirable that you want it and automatically let the ultra filtration to a stop, but the pump  is working. So those are the good, if you want to have an extra safety pay feature, if the patient  has it in the most of the time on the step down, because in our ICU, we have 24 seven, uh,  intensivist. But if you want an extra step or certain level of the volume removal is a parameter  is going to help. And as you said, is the automatically turn off, uh, the ultra filtration  and value are grafted and visible on the console. So another one, uh, important concept that you  have it ultra filtrate is amount of the isotonic fluid is going to come from the intravascular.  So when this machine constantly remove this one, cause the fluid from the interstitial move it,  which we call it plasma refill rate, the fluid is going to go. So if you want to remove it,  the idea should be to get to the steady state, the rate should be about the same. So if you see  on the graph on the right side, so on the beginning, this plasma refill rate is going to be  high, but the more ultra filtration, let's say after eight hours or after 24 hours in certain  patient, then the rate can come is going to be the rates of the plasma refill is going to be  reduced. But that is a judgment called different people. They doing it differently. What usually  you wanted to do it is started with the lower rates of ultra filter, like a 50 to a hundred  and then increase. This machine can go as high as 400 per hour, 500. Sorry about that. So personally,  I use a 400 for a few hours, but massively, and then we came down. But as you said, 400 of 10  hours is required to four liters of the fluid water removal. If somebody get the maintenance  of the, let's say 180 CC because of three or four pressers at the end of the day, not only you  remove the patient is not more volume responsive. You're removing roughly around two liters volume on this patient, which is a significant achievement. Yes. I'm sorry.  What is the whole concept is that, so let's say you can't, you have to estimate it. So when you  dial it on the machine, let's say you want a hundred CC of the fluid removal. So you want  estimated what is the total body water that you have. If you dial and let's say three 50, sometimes  we do it. And then 24 hours, you're removing six liters, but the assumption generally speaking,  we don't want it to total water net on the patient, according to their weight, something  between 2.5 to 3.5 liter volume removal. So it means if you give some people, they get excited.  So they dial this machine up and their expectation is they're going to six liter of the volume.  They remove what happened. Patient become hyperbolemic because the refill does not happen.  So what we want to, at the end of the 24 hours on the actual setting on the patient, we want a  roughly between 2.5 net volume removal. So what we are achieving it, those who get the, let's say  200 CC per hour, I might do it 400 net removal by the ultrafiltration, which at the end of the 24  hours, roughly I'm ranging between 2.5 to 3.5. It's going to come a little bit with the experience,  but the volume removal, this concept should be back of your mind. You remove intravascular. The idea is the interstitial is going to put the volume back.  Another point to get to your point is a different formula. Actually during the 60s, they come with the total body water and the intravascular volume through the hematocrit.  Sensitivity of it is around 70%, but if you look at it, everybody's agrees 12% more than a  actual body weight. If you get the volume, you're going to be a hypervolemia. And then usually the  correction should happen is about 8%. But those are, as I said, with the experience that is going  to come to your... Summary, simplified form of ultrafiltration can be prescribed by any physician.  Training extracorporeal, easy setup and monitoring allowing 4 to 1, approximately 35 milliliter of the extracorporeal, and no significant change to electrolyte balance.  I'm happy to answer any questions.  Yes.  The question is, does this machine affect any certain mitigation? The answer is no.  Pardon me? The antibiotics are no. The only thing if you wanted to do it, just remember, if the patient, let's say you give a vancomycin,  vancomycin when you're on this renal replacement therapy, you are going to change the dosage. This machine does not give you the clearance. What it does is just remove  the volume. So dosage has to be adjusted as a renal failure patient.  Hypernatremia? Hypo. You can actually, you can calculate the total dioxide, body water, and how much... This is actually, if you have it, quite interesting.  We have a few cases that the patient come back to us, we get it, and you have 100% control to don't over-treat it. Because let's say with sodium of 123, expectation is going to be  what at the end of the 12 hours. Precisely we can achieve it, and we have done it.  It's a very important point for hyponatremic patient.  No absolute contraindication.  Is the filter, you know, the  the heparin? The heparin, as I said, most of it, honestly, I don't use it. Let's say if I have a  post-op day five, I might put a little bit like a 500 unit through the circuit. Having said that,  if you have a longer time and the patient has a peripheral access, definitely recommended to bring  the a little bit of the heparin higher. At least 1.5 times of what needs to be done. Because the  design of the some of this study was, they were so involved, particularly between 2002 to 2009,  peripheral access and then heparinization, how they are gonna, reliability of the PTT as you see it.  So what you needed in acute setting, rarely you need it, but you need it for the long term, you need some anticoagulation.  I personally, we use it quite often with the two, I think is essential. As you know,  hypervolumnia, hopefully I initiate this thought that we are very, as an entity, is a parameter we want to take care of it. Certain group of the patient, heart failure,  RV dysfunction, that's one. And the second thing, we don't want it to wait.  So as I'm pretty sure you know it, the creatinine, when you say it, the creatinine, and the clearance creatinine, when you have an AKI, is not the linear. So it's the concept is  unfortunately lots of the people they have it, and then the lab nowadays by the state requirement,  they report to the, if you have a let's say creatinine of 1.6, they estimate your GFR. But somebody with the AKI can have a creatinine of 1.6, the GFR might be 5 cc.  So we look at the urine output, I know a friend of mine actually is in Connecticut, they don't report the estimated GFR. So we are very avid appreciation of this idea of  creatinine acute setting, doesn't tell us what's the GFR would be. And then if you have a hypervolumia, we are going to address it fast because it has an outcome effect.  Any question? All right, thank you so much. Thank you.

Video Summary

The speaker discusses the topic of hypervolemia, particularly in the ICU setting. They mention that fluid overload in surgical patients is strongly correlated with longer stays in the ICU and higher mortality rates. They talk about a device called Aquadex, which is used for ultrafiltration therapy to remove excess fluid. They discuss the clinical evidence for using Aquadex and its effectiveness in reducing duration of ventilation, improving cardiac performance, and reducing the need for blood transfusions. They also mention that Aquadex can be used for extended periods of time and is easy to use with automated setup and operation. They describe the console and blood circuit set for the device and discuss the requirements for venous access. The speaker also addresses questions about anticoagulation, electrolyte balance, and potential contraindications. Overall, they emphasize the importance of early identification and management of hypervolemia in patients, particularly those with heart failure or RV dysfunction.

Asset Subtitle

Pharmacology, Procedures, 2020

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The Society of Critical Care Medicine's Critical Care Congress features internationally renowned faculty and content sessions highlighting the most up-to-date, evidence-based developments in critical care medicine. This is a presentation from the 2020 Critical Care Congress held February 16-19, 2020, in Orlando, Florida, USA.

Hypervolemia is a common complication in the ICU and is associated with increased length of stay and mortality. Ultrafiltration with Aquadex FlexFlow® allows for timely treatment and can be prescribed by any physician trained in extracorporeal therapy. Ultrafiltration has been shown to reduce certain post-operative complications and improve cardiac performance

Hypervolemia in the ICU: A Novel Approach to Fluid Management

Mehdi Oloomi

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Knowledge Area Pharmacology

Knowledge Area Procedures

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Knowledge Level Advanced

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Tag Monitoring

Tag Fluids Resuscitation Management

Year 2020

Keywords

hypervolemia

ICU setting

fluid overload

Aquadex

ultrafiltration therapy

cardiac performance

venous access

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