The time cost of physiologically ineffective intravenous fluids in the emergency department: an observational pilot study employing wearable Doppler ultrasound Article Swipe
Jon‐Émile S. Kenny
,
Stanley O. Gibbs
,
Delaney Johnston
,
Zhen Yang
,
Lisa M. Hofer
,
Mai Elfarnawany
,
Joseph K. Eibl
,
Amanda Johnson
,
Anthony J. Buecker
,
Vivian C. Lau
,
Benjamin O. Kemp
·
YOU?
·
· 2023
· Open Access
·
· DOI: https://doi.org/10.1186/s40560-023-00655-6
YOU?
·
· 2023
· Open Access
·
· DOI: https://doi.org/10.1186/s40560-023-00655-6
Background Little data exist on the time spent by emergency department (ED) personnel providing intravenous (IV) fluid to ‘responsive’ versus ‘unresponsive’ patients. Methods A prospective, convenience sample of adult ED patients was studied; patients were enrolled if preload expansion was indicated for any reason. Using a novel, wireless, wearable ultrasound, carotid artery Doppler was obtained before and throughout a preload challenge (PC) prior to each bag of ordered IV fluid. The treating clinician was blinded to the results of the ultrasound. IV fluid was deemed ‘effective’ or ‘ineffective’ based on the greatest change in carotid artery corrected flow time (ccFT ∆ ) during the PC. The duration, in minutes, of each bag of IV fluid administered was recorded. Results 53 patients were recruited and 2 excluded for Doppler artifact. There were 86 total PCs included in the investigation comprising 81.7 L of administered IV fluid. 19,667 carotid Doppler cardiac cycles were analyzed. Using ccFT ∆ ≥ + 7 ms to discriminate ‘physiologically effective’ from ‘ineffective’ IV fluid, we observed that 54 PCs (63%) were ‘effective’, comprising 51.7 L of IV fluid, whereas, 32 (37%) were ‘ineffective’ comprising 30 L of IV fluid. 29.75 total hours across all 51 patients were spent in the ED providing IV fluids categorized as ‘ineffective.’ Conclusions We report the largest-known carotid artery Doppler analysis (i.e., roughly 20,000 cardiac cycles) in ED patients requiring IV fluid expansion. A clinically significant amount of time was spent providing physiologically ineffective IV fluid. This may represent an avenue to improve ED care efficiency.
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- Type
- article
- Language
- en
- Landing Page
- https://doi.org/10.1186/s40560-023-00655-6
- https://jintensivecare.biomedcentral.com/counter/pdf/10.1186/s40560-023-00655-6
- OA Status
- gold
- Cited By
- 5
- References
- 49
- Related Works
- 10
- OpenAlex ID
- https://openalex.org/W4321002207
All OpenAlex metadata
Raw OpenAlex JSON
- OpenAlex ID
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https://openalex.org/W4321002207Canonical identifier for this work in OpenAlex
- DOI
-
https://doi.org/10.1186/s40560-023-00655-6Digital Object Identifier
- Title
-
The time cost of physiologically ineffective intravenous fluids in the emergency department: an observational pilot study employing wearable Doppler ultrasoundWork title
- Type
-
articleOpenAlex work type
- Language
-
enPrimary language
- Publication year
-
2023Year of publication
- Publication date
-
2023-02-15Full publication date if available
- Authors
-
Jon‐Émile S. Kenny, Stanley O. Gibbs, Delaney Johnston, Zhen Yang, Lisa M. Hofer, Mai Elfarnawany, Joseph K. Eibl, Amanda Johnson, Anthony J. Buecker, Vivian C. Lau, Benjamin O. KempList of authors in order
- Landing page
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https://doi.org/10.1186/s40560-023-00655-6Publisher landing page
- PDF URL
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https://jintensivecare.biomedcentral.com/counter/pdf/10.1186/s40560-023-00655-6Direct link to full text PDF
- Open access
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YesWhether a free full text is available
- OA status
-
goldOpen access status per OpenAlex
- OA URL
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https://jintensivecare.biomedcentral.com/counter/pdf/10.1186/s40560-023-00655-6Direct OA link when available
- Concepts
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Medicine, Emergency department, Preload, Ultrasound, Intravenous fluid, Doppler effect, Doppler ultrasound, Internal medicine, Emergency medicine, Cardiology, Anesthesia, Hemodynamics, Radiology, Psychiatry, Physics, AstronomyTop concepts (fields/topics) attached by OpenAlex
- Cited by
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5Total citation count in OpenAlex
- Citations by year (recent)
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2025: 2, 2024: 2, 2023: 1Per-year citation counts (last 5 years)
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49Number of works referenced by this work
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10Other works algorithmically related by OpenAlex
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