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Báo cáo y học: "Brachial artery flow velocity variation: another victory for hand-carried ultrasound"

Tuyển tập các báo cáo nghiên cứu về y học được đăng trên tạp chí y học Critical Care giúp cho các bạn có thêm kiến thức về ngành y học đề tài: Brachial artery flow velocity variation: another victory for hand-carried ultrasound? | Available online http ccforum.eom content 13 5 195 Commentary Brachial artery flow velocity variation another victory for hand-carried ultrasound Gregory A Schmidt Department of Internal Medicine University of Iowa 200 Hawkins Drive C33-GH Iowa City IA 52246 USA Corresponding author Gregory A Schmidt gregory-a-schmidt@uiowa.edu Published 16 October 2009 This article is online at http ccforum.com content 13 5 195 2009 BioMed Central Ltd Critical Care 2009 13 195 doi 10.1186 cc8120 See related research by Monge García et al. http ccforum.com content 13 5 R142 Abstract Dynamic predictors are clearly superior to static pressures in predicting whether a patient will respond to a fluid bolus. Hand-carried ultrasound HCUS can measure changes in blood flow velocity in the brachial artery that parallel arterial pulse pressure variation. The potential for HCUS to guide fluid therapy non-invasively must overcome problems of sensitivity and applicability. In the past 5 years hand-carried ultrasound HCUS devices have joined the intensivist s toolbox for guiding invasive procedures for analyzing the pathophysiological basis for circulatory shock and for predicting fluid responsiveness by revealing inferior vena caval collapsibility. In a recent paper Monge García and colleagues demonstrated that respiratory-induced variation in brachial artery peak flow velocity AVpeakBA could be measured with HCUS and the result predicted the cardiac output response to a fluid challenge 1 . Fluid therapy for critically ill hemodynamically unstable patients presents clinicians with a dilemma. On the one hand a fluid bolus may augment cardiac output improve critical organ perfusion and even save the patient s life. On the other hand fluid may confer no hemodynamic benefit while adding to pulmonary edema amongst other ills. How often is a fluid bolus harmful as opposed to helpful When an intensivist judges that a fluid bolus is necessary only one-half of patients respond with a meaningful boost in