Browsing by Author "Valenzuela Espinoza, Emilio Daniel"

Now showing 1 - 2 of 2
  • Thumbnail Image
    Item
    Coexistence of a fuid responsive state and venous congestion signals in critically ill patients: a multicenter observational proof-of-concept study
    (2024) Muñoz, Felipe; Born, Pablo; Bruna, Mario; Ulloa, Rodrigo; Gonzalez Almonacid, Cecilia Ignacia; Philp Sandoval, Valerie Rose; Mondaca Pavie, Roberto Francisco     ; Blanco Guerrero, Juan Pablo; Valenzuela Espinoza, Emilio Daniel; Retamal Montes, Jaime; Miralles, Francisco; Wendel-Garcia, Pedro D.; Ospina-Tascón, Gustavo A.; Castro Lopez, Ricardo Adolfo; Rola, Philippe; Bakker, Jan; Hernández P., Glenn; Kattan Tala, Eduardo José
    Background: Current recommendations support guiding fluid resuscitation through the assessment of fluid responsiveness. Recently, the concept of fluid tolerance and the prevention of venous congestion (VC) have emerged as relevant aspects to be considered to avoid potentially deleterious side effects of fluid resuscitation. However, there is paucity of data on the relationship of fluid responsiveness and VC. This study aims to compare the prevalence of venous congestion in fluid responsive and fluid unresponsive critically ill patients after intensive care (ICU) admission. Methods: Multicenter, prospective cross-sectional observational study conducted in three medical–surgical ICUs in Chile. Consecutive mechanically ventilated patients that required vasopressors and admitted < 24 h to ICU were included between November 2022 and June 2023. Patients were assessed simultaneously for fluid responsiveness and VC at a single timepoint. Fluid responsiveness status, VC signals such as central venous pressure, estimation of left ventricular filling pressures, lung, and abdominal ultrasound congestion indexes and relevant clinical data were collected. Results: Ninety patients were included. Median age was 63 [45–71] years old, and median SOFA score was 9 [7–11]. Thirty-eight percent of the patients were fluid responsive (FR+), while 62% were fluid unresponsive (FR−). The most prevalent diagnosis was sepsis (41%) followed by respiratory failure (22%). The prevalence of at least one VC signal was not significantly different between FR+ and FR− groups (53% vs. 57%, p = 0.69), as well as the proportion of patients with 2 or 3 VC signals (15% vs. 21%, p = 0.4). We found no association between fluid balance, CRT status, or diagnostic group and the presence of VC signals. Conclusions: Venous congestion signals were prevalent in both fluid responsive and unresponsive critically ill patients. The presence of venous congestion was not associated with fluid balance or diagnostic group. Further studies should assess the clinical relevance of these results and their potential impact on resuscitation and monitoring practices.
  • No Thumbnail Available
    Item
    Practice of Fluid and Vasopressor Therapy in Critically Ill Invasively Ventilated Patients (PRoFLUID)—study protocol for an international multicenter observational cohort study
    (2024) Valenzuela Espinoza, Emilio Daniel; The PRoFLUID-Investigators
    Background: The practice of intravenous fluid and vasopressor therapy in intensive care unit (ICU) patients, particularly in those who receive invasive ventilation, has been subject to change. Traditional approaches of ‘early and liberal fluid administration’ and ‘late and restrictive vasopressor use’ have been challenged, leading to recommendations for giving less fluids and earlier administration of vasopressors. Recommendations for fluid deresuscitation—active fluid removal—are absent. The global approach to fluid and vasopressor therapy in invasively ventilated patients is currently unclear. Our aim is to explore the practice of intravenous fluid and vasopressor therapy in invasively ventilated ICU patients in a study named ‘Practice of Fluid and Vasopressor Therapy in Critically Ill Invasively Ventilated Patients’ (PRoFLUID). Methods: PRoFLUID is an international, multicenter, observational cohort study in critically ill adult patients that are invasively ventilated for more than 24 hours. The outcomes include various aspects of fluid and vasopressor therapy, urine output and cumulative fluid balances. We will also collect duration of ventilation, lengths of stay and mortality in ICU and hospital. We expect to collect granular data on fluid and vasopressor therapy in a sample of at least 2,500 patients. Discussion: PRoFLUID will provide useful insights into the practice of fluid and vasopressor therapy in invasively ventilated critically ill patients. PRoFLUID also allows us to determine whether geo-economic differences in management of intravenous fluid and vasopressor therapy exist, and allows for analyses of associations of aspects of fluid and vasopressor therapy with outcomes. Last but not least, its findings could feed sample size calculations of future randomized clinical trials of fluid and vasopressor therapy. In conclusion, PRoFLUID will collect data on fluid and vasopressor therapy in invasively ventilated ICU patients worldwide, providing insights that will guide future clinical decisions and randomized trial designs. Trial Registration: ClinicalTrials.gov NCT05968066. Registered on August