Comprehensive Assessment of Fluid Status by Point-of-Care Ultrasonography

Abstract

The management of complex fluid and electrolyte disorders is central to the practice of nephrologists. The sensitivity of physical examination alone to determine fluid status is limited, precluding accurate clinical decision making. Point-of-Care Ultrasonography (POCUS) is emerging as a valuable non-invasive bedside diagnostic tool for objective evaluation of physiological and hemodynamic parameters related to fluid status, tolerance, and responsiveness. Rapid bedside sonographic evaluation can obtain qualitative data on cardiac function as well as quantitative data on pulmonary congestion. Advanced POCUS, including goal-directed Doppler echocardiography provides additional quantitative information including flow velocities and pressures across the cardiac structures. Recently, abnormal Doppler flow patterns in abdominal organs secondary to increased right atrial pressure have been linked to congestive organ damage adding another component to the hemodynamic assessment. Integrating POCUS findings with clinical and laboratory data can further elucidate a patient's hemodynamic status. This drives decisions regarding crystalloid administration or, conversely, diuresis or ultrafiltration and allows tailored therapy for individual patients. In this article, we provide an overview of the focused assessment of cardiovascular function, pulmonary and venous congestion using POCUS and review relevant literature.