The Trendelenburg Twist: A Better Way to Predict Fluid Needs in ARDS Patients on VV-ECMO

Fluid management is tricky for patients on veno-venous extracorporeal membrane oxygenation (VV-ECMO) with acute respiratory distress syndrome (ARDS). Too much fluid can make things worse. So, predicting how well a patient will respond to fluids is crucial. A study in an intensive care unit (ICU) looked at 51 such patients in the prone position (PP). They measured changes in stroke volume index (ΔSVI), pulse pressure variation (PPV), and other factors before and after the Trendelenburg position or fluid addition. Fluid responsiveness was defined as a 15% or more increase in stroke volume index after fluid expansion. About two-thirds of the patients were found to be fluid responders. The Trendelenburg position (ΔSVI Trend ), baseline carotid corrected flow time (FTc Baseline ), and changes in carotid artery blood flow peak velocity (ΔVpeak CA ) were the best at predicting fluid responsiveness. The Trendelenburg position had the highest accuracy, with a sensitivity of 82% and specificity of 83%. FTc Baseline was also highly accurate and easier to measure. These methods can help doctors decide if a patient needs more fluids or not. The Trendelenburg position is a bit tricky to perform, but FTc Baseline is simpler and doesn't require any special positions or extra fluids. It's like a quick check that can guide doctors in their fluid management decisions.