LAUSR

Introduction/Hypothesis: Assessment of volume status is a common clinical dilemma in critically ill patients. Point-of-care (POC) echocardiography can provide these clinical answers by measuring cardiac filling pressures. We propose a focused method to assess estimated left ventricular (LV) filling pressures by POC echocardiography with 2 of the validated 5 measurements (mitral inflow velocity E and average E/e’). We hypothesize that these POC measurements are reliable amongst two providers and have dynamic changes during large fluid shifts (hydration or diuresis). Methods: We conducted a pilot observational study of a convenience sample of end stage renal disease (ESRD) patients undergoing at least two liters fluid removal during outpatient hemodialysis and measured ventricular filling pressure (mitral inflow velocity E and average annual e′) prior to and after hemodialysis. Ultrasound images were obtained by two POCUS-trained physicians who were blinded to each other’s measurements. Wilcoxon matched signed-rank test or paired t-test were used for descriptive analysis and the duration of time to capture sonographic measurements is reported. Results: 32 patients were enrolled. There was no systematic difference in E and e′ velocity measurements between two providers (p > 0.05, either paired t-test or Wilcoxon matched signedrank test). The mean E velocity between the two providers was 81.6 ± 26.2 cm/s (mean ± sd) and 78.6 ± 26.0 cm/s before and after dialysis respectively (p = 0.03, paired t test). The median septal e′ before and after dialysis is 5.5 cm/s (range 3.5-10) and 5.0 cm/s (range 3.0-8.0) amongst two providers (p = 0.02, Wilcoxon matched signed-rank test). The median E/e′ before and after dialysis is 12.4 (range 5.6 25.9) and 12.0 (range 5.1 30.4) amongst two providers by (p = 0.64, Wilcoxon matched signed-rank test). The average volume of fluid removed during hemodialysis was 3.2 ± 1.08 Liters. Conclusions: Focused POC echocardiographic measurements of ventricular filling pressure are efficient and reproducible. There was not a statistically significant change in the average E/e′ after three liters of fluid removal in ESRD patients. Measuring E/e′ with POC echocardiography can offer a time efficient way to assess LV filling pressures and intravascular volume status in critically ill patients.