Improving Fluid Resuscitation Through Dynamic Assessment With Wearable Doppler Point-of-Care Ultrasonography: A Quality Improvement Initiative

Objective: As a quality improvement initiative, dynamic point-of-care ultrasound (POCUS) assessments were introduced to our large nonprofit academic medical center to improve adherence with society resuscitation guidelines. Sonography-guided volume resuscitation decisions were based on dynamic assessments and integration into workflow. Materials and Methods: The medical team independently assessed volume status using existing methods (eg, physical examination, static POCUS) in hypo-perfusing or hypotensive patients (N = 50). A wearable Doppler POCUS device was used to perform a dynamic assessment of fluid responsiveness, specifically measuring the change in stroke volume surrogate after preload challenge. The interventions and outcomes were followed over 3 subsequent days. An anonymous survey was sent to those clinicians involved in the project. Results: Point-of-care ultrasound utilization rate improved, and intravenous fluid resuscitation administration decreased. Dynamic POCUS assessment provided clear categorization as fluid responsive or nonresponsive even in cases when volume status was unclear using existing methods. Physicians and nurses reported no adverse safety events, and the dynamic assessment influenced clinical decision-making in 76% of cases. Fluid-nonresponsive patients (ie, stroke volume change less than 10% after preload challenge) were more likely to need oxygen therapy or to die in the 3 days following assessment in a post hoc analysis. Conclusion: In this project, a wearable POCUS device was successfully integrated into workflow to improve compliance with current society guidelines. These dynamic assessments impacted clinical decision-making in most cases and were found to be particularly useful in cases of unclear volume status assessment.