Thread by @GoughCJ

This is my first critical care echo case tweetorial. I will be discussing the assessment of potential fluid responsiveness in critical care. Case today, answers tomorrow.

Please do give me honest feedback so I can make these useful.

The case is a post-op patient who is hypotensive. They have had some fluid resuscitation already. Do they need more filling? Do they need inotropes? Do they need vasopressors?

They are intubated and fully ventilated.

Here is the PLAX.

And here is the A4C.

Thinking specifically about potential fluid responsiveness:
1. You increase the TV on the ventilator to 8ml/kg.
2. The patient is fully ventilated, with no spontaneous breaths.

Here is the VTI variation at the LVOT.

The variation is 7%.

You perform a passive leg raise (PLR), and then repeat the LVOT VTI assessment.

So here are the VTIs post-PLR.

The average VTI has gone from 21.35 in the last image (pre-PLR) to 20.55 now (post-PLR). Pretty much no change.

You have a look at the IVC.

Variation of 9%.

So, what do you think? Please vote below.

Answers tomorrow!

Forgot to tag anyone in this - schoolboy error.

So...
@nat_echo @cardiacLucy @dr_benoy_n_shah @DrDanAugustine @vitormweaverBSE @samjc1976 @PetermoranPeter @scrivsy85

Please feel free to re-tweet and share. This is pretty frequent query on ITU.