Avaliação da ultrassonografia ultraportátil à beira do leito, como fator preditivo de hipotensão em pacientes sob terapia renal substitutiva

Abstract

The presence of hypotension during hemodialysis is common and associated with lower efficiency of the procedure and greater lethality. The ultrafiltration rate is performed to reduce water overload, as this is known to be associated with a greater risk of acute kidney injury and greater lethality in the intensive care patient population. However, the assessment of fluid overload in critically ill patients is challenging, as pulmonary congestion is poorly correlated with clinical signs. Pulmonary and inferior vena cava evaluation with ultrasound has been increasingly performed in patients with acute kidney injury to better assess the patient's volume status and predict with good accuracy which one’s benefit from greater or lesser ultrafiltration, minimizing the chance of hemodynamic instability during the procedure. A new ultraportable ultrasound technology, the Butterfly IQ ultrasound-on-chip technology, allows the repeated assessment of multiple patient parameters during renal replacement therapy, and can serve as an instrument for reevaluating the ultrafiltration initially programmed before the development of hypotension, avoiding interruption of the method due to instability, and allowing modification of the initially defined ultrafiltration. Therefore, the objective of this investigation was to serially evaluate lung ultrasound parameters (B lines) and the dynamics of variation in the diameter of the inferior vena cava at different times before the start and after the start of renal replacement therapy (30 minutes and 60 minutes) and correlate the findings with the development of intradialytic hypotension (MAP < 60) and/or interruption of the method. The evaluations were carried out after validating the instrument, which showed similar accuracy compared to conventional ultrasound. Ultraportable technology showed good correlation with traditional ultrasound, and the use of Vena Cava dynamics assessment proved to be a useful tool in early predicting hypotension during the dialysis procedure.