RESUMO
BACKGROUND: Evaluation of the venous system has long been underestimated as an important component of the circulatory system. As systemic venous pressure increases, the perfusion pressure to the tissues is compromised. During initial resuscitation in cardiac surgery, excessive fluid administration is associated with increased morbidity and mortality. METHODS: We conducted a cross-sectional study of 60 consecutive adult patients who underwent cardiac surgery and in whom it was possible to obtain the venous excess ultrasound (VExUS) grading system and mean systemic filling pressure (Pmsf) in the postoperative period upon admission, at 24 and 48 h. We then determined the correlation between VExUS grading and Pmsf. RESULTS: On admission, patients with VExUS grading 0 predominated, with a progressive increase in venous congestion and an increase in Pmsf over the course of the first 48 h. There was a strong positive correlation between VExUS grading and the invasive measurement of Pmsf at 24 and 48 h after arrival. The presence of grade 2 or grade 3 venous congestion in the postoperative period poses an increased risk of developing acute kidney injury. CONCLUSION: The VExUS grading system indicates a high degree of systemic venous congestion in the first 48 h of the postoperative period after cardiac surgery and correlates with the Pmsf, which is the best surrogate of stressed circulatory volume.
Assuntos
Procedimentos Cirúrgicos Cardíacos , Sistema Cardiovascular , Hiperemia , Humanos , Estudos TransversaisRESUMO
Uno de los retos para el cardiólogo es conseguir una volemia óptima, es decir, mejorar el gasto cardiaco, evitando un exceso de volemia que pudiera favorecer un pronóstico negativo. Actualmente se sabe que el balance positivo se asocia con un incremento en la mortalidad; en la actualidad contamos con diversos parámetros para evaluar la precarga; sin embargo, ninguno es altamente fidedigno. El objetivo del presente artículo de revisión es dar un recordatorio de este concepto fisiológico así como sus utilidades en el monitoreo del paciente.
One challenge for the cardiologist is to achieve optimal blood volume for to improve cardiac output, and avoid excessive blood volume that could favor a negative prognosis. Now is known that the positive balance is associated with increased mortality; today we have different standards for assessing preload yet none is highly reliable; the objective of this review is to give a reminder of its physiological concept and profits in patient monitoring.