Vt Challenge:
A transient increase in Vt from 6 mL/kg to 8 mL/kg for one minute, with a PPV increase ≥3.5%, suggests preload responsiveness.
Benefits include simplicity and minimal equipment requirements.
Threshold variability and false positives in ACP remain concerns.
End-Expiratory Occlusion Test:
A 15-second interruption of ventilation at end-expiration increases preload, and a rise in cardiac output ≥5% confirms preload responsiveness.
Portal vein Doppler with normal D and S waves
Portal vein Doppler with mild variability
renal vein Doppler with discontinuous biphasic flow
@Ibrahim Ameen
The PRECISE trial aims to assess whether an electronic health record (EHR) alert recommending balanced crystalloids over normal saline for patients with group D sepsis reduces 30-day inpatient mortality. This pragmatic, randomized trial uses a machine learning algorithm to identify patients with a sepsis subphenotype (group D), previously shown to benefit from balanced crystalloids. The trial, conducted across multiple hospitals, could significantly influence sepsis resuscitation guidelines by introducing a precision medicine approach.
The group D sepsis sub-phenotype is characterized by lower body temperature, heart rate, and respiratory rate, along with hypotension. Patients in this group are typically older and show higher vasopressor use. Importantly, group D has a significantly higher 30-day mortality risk. However, in the SMART trial, group D patients experienced a substantial reduction in mortality when treated…
Late systolic reversal with blunted systolic flow indicating high RA pressure with big A wave makes it due to either tricuspid stenosis or complete heart block