Basic principles of ultrasound-assisted choice of strategy for targeted infusion therapy
Objective. Optimization of fluid therapy in emergency medicine.
Materials and methods: 1) conceptual four-phase liquid resuscitation model; 2) conceptual approach of infusion therapy management is based on an assessment of the four main components of haemocirculation: a vascular content, tone and integrity, blood flow; 3) fast bedside ultrasound algorithm for differential diagnosis of shocks and infusion resuscitation protocol using ultrasound of the inferior vena cava (preload assessment) and lungs (early detection of extravascular fluid).
Results. Using the selected methods, it is possible to clearly determine the optimal target-oriented infusion strategy depending on the volemic status and the state of hemodynamics, the parameters of which can be estimated using ultrasound: vascular content – inferior vena cava (caliber and breathing variations); vascular tone – caliber of the tibia artery; vascular integrity – loss assessment in the third space (physiological cavities and interstitium of the lungs); blood flow – Doppler Echo.
Conclusions. The use of diagnostic ultrasound allows to optimize tissue perfusion, keeping the intravascular fluid volume in a certain range by sorting patients into three categories of fluid management: infusion resuscitation, tested infusion, limiting infusion and early use of vasopressors, which reduces the number of adverse effects and the incidence of complications.
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