Monitoring the circulatory responses of shocked patients during fluid resuscitation in the emergency department

Objectives: To assess the feasibility of constructing left ventricular resp onse curves non-invasively during the fluid resuscitation of critically ill patients in the emergency department (ED) using a portable suprasternal Do ppler ultrasound (PSSDU) device. Design: Prospective case series. Setting: Emergency department, Catholic University of Leuven, Belgium. Pati ents: Shocked patients in the ED were diagnosed by predefined criteria. Onl y those thought to require standardised intravenous colloid challenges were observed i.e., sequential boluses of 3.5 ml/kg/ 10 min titrated against ch anges in stroke distance (Doppler surrogate for left ventricular stroke vol ume). Results: A total of 50 shocked patients were studied. Stroke distance was m easurable in 45 patients. 35 patients were fluid responders in terms of str oke distance. Group mean stroke distance increased during resuscitation (8. 6 +/- 4.1 cm to 19.5 +/- 4.6 cm, P < 0.001) and then reached a plateau valu e (19.6 +/- 4.6 cm, P = 0.488). No response to fluid was seen in nine patie nts of which eight had severe sepsis, Alternative therapeutic approaches in creased stroke distance for all of these patients. Evidence for right vent ricular dysfunction was found as a cause for fluid non-response in the majo rity of patients with sepsis. Conclusions: Previous experimental work has shown that changes in central b lood flow can be derived using the PSSDU device. This clinical feasibility study suggests that the PSSDU can help tailor haemodynamic therapy for an i ndividual patient and give an early indication of treatment failure in the ED.