Monitoring modalities and assessment of fluid status: A practice management guideline from the Eastern Association for the Surgery of Trauma

David S. Plurad, William Chiu, Ali S. Raja, Samuel M. Galvagno, Uzer Khan, Dennis Y. Kim, Samuel A. Tisherman, Jeremy Ward, Mark E. Hamill, Vicki Bennett, Brian Williams, Bryce Robinson

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

BACKGROUND Fluid administration in critically ill surgical patients must be closely monitored to avoid complications. Resuscitation guided by invasive methods are not consistently associated with improved outcomes. As such, there has been increased use of focused ultrasound and Arterial Pulse Waveform Analysis (APWA) to monitor and aid resuscitation. An assessment of these methods using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) framework is presented. METHODS A subsection of the Surgical Critical Care Task Force of the Practice Management Guideline Committee of EAST conducted two systematic reviews to address the use of focused ultrasound and APWA in surgical patients being evaluated for shock. Six population, intervention, comparator, and outcome (PICO) questions were generated. Critical outcomes were prediction of fluid responsiveness, reductions in organ failures or complications and mortality. Forest plots were generated for summary data and GRADE methodology was used to assess for quality of the evidence. Reviews are registered in PROSPERO, the International Prospective Register of Systematic Reviews (42015032402 and 42015032530). RESULTS Twelve focused ultrasound studies and 20 APWA investigations met inclusion criteria. The appropriateness of focused ultrasound or APWA-based protocols to predict fluid responsiveness varied widely by study groups. Results were mixed in the one focused ultrasound study and 9 APWA studies addressing reductions in organ failures or complications. There was no mortality advantage of either modality versus standard care. Quality of the evidence was considered very low to low across all PICO questions. CONCLUSION Focused ultrasound and APWA compare favorably to standard methods of evaluation but only in specific clinical settings. Therefore, conditional recommendations are made for the use of these modalities in surgical patients being evaluated for shock. LEVEL OF EVIDENCE Systematic Review, level II.

Original languageEnglish (US)
Pages (from-to)37-49
Number of pages13
JournalJournal of Trauma and Acute Care Surgery
Volume84
Issue number1
DOIs
StatePublished - Jan 1 2018

Fingerprint

Practice Management
Practice Guidelines
Resuscitation
Shock
Wounds and Injuries
Mortality
Advisory Committees
Critical Care
Critical Illness
Population

Keywords

  • arterial pulse waveform analysis
  • critical care
  • Focused ultrasound
  • organ failure
  • resuscitation
  • shock

ASJC Scopus subject areas

  • Surgery
  • Critical Care and Intensive Care Medicine

Cite this

Monitoring modalities and assessment of fluid status : A practice management guideline from the Eastern Association for the Surgery of Trauma. / Plurad, David S.; Chiu, William; Raja, Ali S.; Galvagno, Samuel M.; Khan, Uzer; Kim, Dennis Y.; Tisherman, Samuel A.; Ward, Jeremy; Hamill, Mark E.; Bennett, Vicki; Williams, Brian; Robinson, Bryce.

In: Journal of Trauma and Acute Care Surgery, Vol. 84, No. 1, 01.01.2018, p. 37-49.

Research output: Contribution to journalArticle

Plurad, DS, Chiu, W, Raja, AS, Galvagno, SM, Khan, U, Kim, DY, Tisherman, SA, Ward, J, Hamill, ME, Bennett, V, Williams, B & Robinson, B 2018, 'Monitoring modalities and assessment of fluid status: A practice management guideline from the Eastern Association for the Surgery of Trauma', Journal of Trauma and Acute Care Surgery, vol. 84, no. 1, pp. 37-49. https://doi.org/10.1097/TA.0000000000001719
Plurad, David S. ; Chiu, William ; Raja, Ali S. ; Galvagno, Samuel M. ; Khan, Uzer ; Kim, Dennis Y. ; Tisherman, Samuel A. ; Ward, Jeremy ; Hamill, Mark E. ; Bennett, Vicki ; Williams, Brian ; Robinson, Bryce. / Monitoring modalities and assessment of fluid status : A practice management guideline from the Eastern Association for the Surgery of Trauma. In: Journal of Trauma and Acute Care Surgery. 2018 ; Vol. 84, No. 1. pp. 37-49.
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abstract = "BACKGROUND Fluid administration in critically ill surgical patients must be closely monitored to avoid complications. Resuscitation guided by invasive methods are not consistently associated with improved outcomes. As such, there has been increased use of focused ultrasound and Arterial Pulse Waveform Analysis (APWA) to monitor and aid resuscitation. An assessment of these methods using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) framework is presented. METHODS A subsection of the Surgical Critical Care Task Force of the Practice Management Guideline Committee of EAST conducted two systematic reviews to address the use of focused ultrasound and APWA in surgical patients being evaluated for shock. Six population, intervention, comparator, and outcome (PICO) questions were generated. Critical outcomes were prediction of fluid responsiveness, reductions in organ failures or complications and mortality. Forest plots were generated for summary data and GRADE methodology was used to assess for quality of the evidence. Reviews are registered in PROSPERO, the International Prospective Register of Systematic Reviews (42015032402 and 42015032530). RESULTS Twelve focused ultrasound studies and 20 APWA investigations met inclusion criteria. The appropriateness of focused ultrasound or APWA-based protocols to predict fluid responsiveness varied widely by study groups. Results were mixed in the one focused ultrasound study and 9 APWA studies addressing reductions in organ failures or complications. There was no mortality advantage of either modality versus standard care. Quality of the evidence was considered very low to low across all PICO questions. CONCLUSION Focused ultrasound and APWA compare favorably to standard methods of evaluation but only in specific clinical settings. Therefore, conditional recommendations are made for the use of these modalities in surgical patients being evaluated for shock. LEVEL OF EVIDENCE Systematic Review, level II.",
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AU - Galvagno, Samuel M.

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AU - Kim, Dennis Y.

AU - Tisherman, Samuel A.

AU - Ward, Jeremy

AU - Hamill, Mark E.

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AU - Williams, Brian

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N2 - BACKGROUND Fluid administration in critically ill surgical patients must be closely monitored to avoid complications. Resuscitation guided by invasive methods are not consistently associated with improved outcomes. As such, there has been increased use of focused ultrasound and Arterial Pulse Waveform Analysis (APWA) to monitor and aid resuscitation. An assessment of these methods using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) framework is presented. METHODS A subsection of the Surgical Critical Care Task Force of the Practice Management Guideline Committee of EAST conducted two systematic reviews to address the use of focused ultrasound and APWA in surgical patients being evaluated for shock. Six population, intervention, comparator, and outcome (PICO) questions were generated. Critical outcomes were prediction of fluid responsiveness, reductions in organ failures or complications and mortality. Forest plots were generated for summary data and GRADE methodology was used to assess for quality of the evidence. Reviews are registered in PROSPERO, the International Prospective Register of Systematic Reviews (42015032402 and 42015032530). RESULTS Twelve focused ultrasound studies and 20 APWA investigations met inclusion criteria. The appropriateness of focused ultrasound or APWA-based protocols to predict fluid responsiveness varied widely by study groups. Results were mixed in the one focused ultrasound study and 9 APWA studies addressing reductions in organ failures or complications. There was no mortality advantage of either modality versus standard care. Quality of the evidence was considered very low to low across all PICO questions. CONCLUSION Focused ultrasound and APWA compare favorably to standard methods of evaluation but only in specific clinical settings. Therefore, conditional recommendations are made for the use of these modalities in surgical patients being evaluated for shock. LEVEL OF EVIDENCE Systematic Review, level II.

AB - BACKGROUND Fluid administration in critically ill surgical patients must be closely monitored to avoid complications. Resuscitation guided by invasive methods are not consistently associated with improved outcomes. As such, there has been increased use of focused ultrasound and Arterial Pulse Waveform Analysis (APWA) to monitor and aid resuscitation. An assessment of these methods using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) framework is presented. METHODS A subsection of the Surgical Critical Care Task Force of the Practice Management Guideline Committee of EAST conducted two systematic reviews to address the use of focused ultrasound and APWA in surgical patients being evaluated for shock. Six population, intervention, comparator, and outcome (PICO) questions were generated. Critical outcomes were prediction of fluid responsiveness, reductions in organ failures or complications and mortality. Forest plots were generated for summary data and GRADE methodology was used to assess for quality of the evidence. Reviews are registered in PROSPERO, the International Prospective Register of Systematic Reviews (42015032402 and 42015032530). RESULTS Twelve focused ultrasound studies and 20 APWA investigations met inclusion criteria. The appropriateness of focused ultrasound or APWA-based protocols to predict fluid responsiveness varied widely by study groups. Results were mixed in the one focused ultrasound study and 9 APWA studies addressing reductions in organ failures or complications. There was no mortality advantage of either modality versus standard care. Quality of the evidence was considered very low to low across all PICO questions. CONCLUSION Focused ultrasound and APWA compare favorably to standard methods of evaluation but only in specific clinical settings. Therefore, conditional recommendations are made for the use of these modalities in surgical patients being evaluated for shock. LEVEL OF EVIDENCE Systematic Review, level II.

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