Bedside Echo to Assess Volume Status

Jessica Nelson, MD and Jason Brainard, MD

“What’s the patients volume status?”

Left Ventricular Size

• Useful predictor of fluid responsiveness• Small and hyperkinetic LV corresponds to low preload• Wall effacement• Use in context of entire clinical picture• Also evaluate for:

• Ejection fraction• Wall motion abnormalities• Pericardial effusion

Volume Responsive- PS Long

Volume Responsive- PS Short

Volume Responsive- Apical 4

Volume Overload- Parasternal Long

Volume Overload- PS Short

Volume Overload- R Heart

Volume Overload- Apical 4

Inferior Vena Cava Assessment

• Assess IVC diameter near hepatic veins• Respiratory variations of IVC>50% correspond to CVP

Volume Overload- IVC

Other Signs of Volume Overload

• RA and RV distension• Pleural effusions• Pulmonary Edema - B lines and comets on lung US

Left Pleural Effusion

Right Pleural Effusion

Comet Tail Artifacts on Lung US

Bedside Echo to Assess Volume Status“What’s the patients volume status?”Left Ventricular SizeVolume Responsive- PS LongVolume Responsive- PS ShortVolume Responsive- Apical 4Volume Overload- Parasternal LongVolume Overload- PS ShortVolume Overload- R HeartVolume Overload- Apical 4Inferior Vena Cava AssessmentVolume Overload- IVCOther Signs of Volume Overload Left Pleural EffusionRight Pleural EffusionComet Tail Artifacts on Lung US