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2026, Number 4

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Med Crit 2026; 40 (4)

Preload evaluation by ultrasound in patients with modifications in portal circulation

Flores MEM, Fabregat PJG, Chávez PCE, Sánchez NVM

Language: Spanish
References: 29
Page: 262-268
PDF size: 1134.88 Kb.


ABSTRACT

Introduction: accurate assessment of fluid volume in critically ill patients, especially those with portal circulation modifications following specific surgical procedures, represents a major clinical challenge. Traditional methods, such as central venous pressure and pulmonary artery occlusion pressure, have reliability limitations due to anatomical and physiological alterations. Renal ultrasonography, a noninvasive and easily accessible technique, has emerged as a promising alternative for assessing systemic venous preload and congestion, allowing for a dynamic and repeatable assessment in critical care medicine. Objectives: to evaluate the usefulness of renal ultrasound for measuring preload in postoperative patients with portal circulation changes. The aim was to analyze the correlation of renal ultrasound parameters, such as intrarenal flow patterns, with traditional invasive methods and to determine their predictive capacity for improving hemodynamic management in this patient group. Material and methods: a retrospective, observational, cross-sectional, and analytical study was conducted in patients over 18 years of age admitted to Intensive Care after surgeries that altered portal circulation. Patients with invasive hemodynamic monitoring and evaluation with renal ultrasound in the postoperative period were included. Comparison of ultrasound measurements with invasive values was performed using descriptive statistical analysis, hypothesis testing, and logistic regression models, considering a statistical significance of p ≤ 0.05. Results: ten patients were included, 70% men, with a mean age of 58.3 ± 18.9 years. Liver transplantation was the most frequent surgery (80%). A significant correlation was observed between the shape of the renal venous flow loop and invasive hemodynamic parameters such as central venous pressure (r = 0.841, p = 0.002), wedge pressure (r = 0.801, p = 0.005), indexed systemic vascular resistance (r = −0.661, p = 0.037), and cardiac index (r = 0.801, p = 0.005). Significant differences were identified in central venous pressure (CVP), wedge pressure, indexed systemic vascular resistance, and cardiac index according to the type of renal venous flow loop. No significant correlation was found with stroke volume variability, cardiac output, or response to fluid therapy. Conclusions: renal ultrasonography has proven to be a promising, noninvasive tool for assessing systemic venous preload and congestion in patients with portal circulation changes, especially in the context of liver transplantation. The significant correlation between renal venous flow pattern and invasive measurements such as CVP and wedge pressure suggests that this technique could be used as a predictor of volume status. However, studies with larger sample sizes are needed to validate its usefulness in fluid therapy management and predict response.


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