Russell R Miller1, E Wesley Ely. 1. Department of Medicine, Division of Allergy/Pulmonary/Critical Care Medicine of the Vanderbilt University School of Medicine, Nashville, Tennessee 37232-8300, USA. russell.miller@vanderbilt.edu
Abstract
PURPOSE OF REVIEW: A valid, low-cost, high-yield instrument to assess intravascular volume status in critically ill patients does not exist. The portable chest X-ray is a common part of any intensivist's or chest clinician's daily rounds. RECENT FINDINGS: A simple, objective, valid measure of intravascular volume status, the vascular pedicle width, remains underappreciated in the medical literature. While more invasive, more expensive, and less common technologies are looked upon to assist in the clinical evaluation of volume status among critically ill patients, the vascular pedicle width stands alone in its low-cost, nearly risk-free potential to impact clinical practice. Even as the daily chest X-ray has become less common in practice, the role of measuring vascular pedicle width is potentially significant, particularly among mechanically ventilated patients. A standardized approach to reading the portable chest X-ray (supine or erect) is needed to facilitate interpretation of complex medical problems among the critically ill. Prospective evaluation of its appropriate use, particularly as compared with other, typically more invasive measures of intravascular volume, is warranted. SUMMARY: Vascular pedicle width measurement using a standardized approach to daily chest X-ray interpretation represents untapped potential for improving the non-invasive assessment of volume status in critically ill patients.
PURPOSE OF REVIEW: A valid, low-cost, high-yield instrument to assess intravascular volume status in critically ill patients does not exist. The portable chest X-ray is a common part of any intensivist's or chest clinician's daily rounds. RECENT FINDINGS: A simple, objective, valid measure of intravascular volume status, the vascular pedicle width, remains underappreciated in the medical literature. While more invasive, more expensive, and less common technologies are looked upon to assist in the clinical evaluation of volume status among critically ill patients, the vascular pedicle width stands alone in its low-cost, nearly risk-free potential to impact clinical practice. Even as the daily chest X-ray has become less common in practice, the role of measuring vascular pedicle width is potentially significant, particularly among mechanically ventilated patients. A standardized approach to reading the portable chest X-ray (supine or erect) is needed to facilitate interpretation of complex medical problems among the critically ill. Prospective evaluation of its appropriate use, particularly as compared with other, typically more invasive measures of intravascular volume, is warranted. SUMMARY: Vascular pedicle width measurement using a standardized approach to daily chest X-ray interpretation represents untapped potential for improving the non-invasive assessment of volume status in critically ill patients.
Authors: Rogerio da Hora Passos; Juliana Ribeiro Caldas; Joao Gabriel Rosa Ramos; Erica Batista Dos Santos Galvão de Melo; Marcelo Augusto Duarte Silveira; Paulo Benigno Pena Batista Journal: Sci Rep Date: 2021-12-08 Impact factor: 4.379