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
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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!