We've spoken about the concepts of venous congestion being problematic beyond just pulmonary edema. I've had Phil Rola on in the past to discuss Venous-side issues such as Renal Compartment Syndrome, the Vexus score, and other issues of the under-respected side of the circulation.
Prior Episodes
- EMCrit Podcast 240 – Renal Compartment Syndrome – It's all about the Venous Side and We've Been Fracking it up for Years
- EMCrit Podcast 263 – The Venous Side Part 1 – VEXUS Score with Phillipe Rola
Today we go further into these concepts, with some concentration on the micro-circulation. There may be quite deleterious effects from iatrogenic volume overload–especially when we are compelled by government regulation to go against our clinical gestalt.
Journal Articles
- Blood pressure deficits in acute kidney injury: not all about the mean arterial pressure?
- Renal Perfusion Pressure < 60 predisposes to kidney injury
- There is individual variation on micro-circ from NorEpi
- CVP affects Microcirc Flow (Editorial)
- Physiology of the Microcirculation
- Perioperative Blood Pressure
- Sublingual Microcirculatory Microscopy
- Hot off the Press: Relative Hypotension and Adverse Kidney-related Outcomes among Critically Ill Patients with Shock. A Multicenter, Prospective Cohort Study. Am J Respir Crit Care Med. 2020 Nov 15;202(10):1407-1418. doi: 10.1164/rccm.201912-2316OC.
Special Mention to Ince on Microcirculatory Hemodynamic Coherence
Now on to the Podcast…
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Editor-in-Chief, at EMCrit.org
An ED Intensivist from NY.
Professor
Chief, Division of Emergency Critical Care
Director, Resuscitation and Acute Critical Care Unit
Stony Brook Medicine
Stony Brook, NY, USA
No conflicts of interest (coi).
Professor
Chief, Division of Emergency Critical Care
Director, Resuscitation and Acute Critical Care Unit
Stony Brook Medicine
Stony Brook, NY, USA
No conflicts of interest (coi).
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This is excellent. Venous congestion due to volume overload is a very under-appreciated issue, especially for those kidneys. Always a fan of early, aggressive de-resuscitation and conservative fluid use. Little bit of pressor is OK, get some fluid off, improve flow and perfusion. Thanks for spreading the word!