Thread by @icmteaching

@iceman_ex @avkwong Really interesting study. Before I read it I assumed that 'physiological assessment' would be lots of fluid responsiveness assessment and then filling to an unresponsive (pathological) state. In fact a lot of ultrasound was used. And there was no difference in fluid administered

@iceman_ex @avkwong So why did US not help? Echo doesn't tell you whether there is hypovolaemia or not. A hyperdynamic heart is a feature of low venous return which is more often from venoplegia than hypovolaemia. Echo cannot distinguish between these.

@iceman_ex @avkwong Lung US shows if there is pulmonary oedema or not. You have to be significantly fluid overloaded to develop this though and its absence is definitely not a sign to give fluid.

@iceman_ex @avkwong It doesn't look like venous scanning (vexus) was used at all (after all there are only a handful of people doing this at the moment).

@iceman_ex @avkwong Not much fluid responsiveness scanning was done. This suggests that the ultrasound that was used was rudimentary. Also even if FR had been looked for this tells you little about whether you should give fluid (only that you definitely shouldn't if FR -ve)

@iceman_ex @avkwong US in general is useful to diagnose significant fluid overload. Other than that it should be used for telling you about things other than fluid state (heart disease, lung disease etc)

@iceman_ex @avkwong Patients only need fluid resuscitating if they are significantly ECF dehydrated or bleeding. These are obvious from the history. Relying on US or cardiac output monitors or whatever for fluid resus demonstrates a misunderstanding of their use and will lead to bad decision making.