Objective assessment of fluid status is of utmost significance in the management of patients with complex disorders involving hemodynamics and multi-organ crosstalk such as cardiorenal or hepatorenal syndrome. The role of volume expansion using intravenous albumin in the setting of hepatorenal syndrome has been an everlasting debate among clinicians. With the accumulating evidence on the deleterious consequences of iatrogenic fluid overload, empiric albumin administration in these patients has been the focus of much attention, and the findings of recent studies suggest a higher incidence of pulmonary complications with albumin. Poor sensitivity of conventional physical examination has led to an interest in the utility of novel noninvasive bedside tools such as point-of-care ultrasonography (POCUS) to evaluate hemodynamics more precisely. Once confined to specialties such as obstetrics and emergency medicine, the scope of diagnostic POCUS is rapidly expanding in other fields including internal medicine and nephrology. Herein, we offer our perspective on the emerging role of POCUS for objective evaluation of patients with suspected hepatorenal physiology based on our experience. We propose that future clinical trials consider incorporating this strategy and explore the impact of POCUS-guided therapy on the outcomes.
Cardiorenal Med

中文翻译：

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肝硬化患者输注白蛋白：POCUS 增强体格检查时间

体液状态的客观评估对于涉及血流动力学和多器官串扰（如心肾综合征或肝肾综合征）的复杂疾病患者的管理具有极其重要的意义。使用静脉注射白蛋白进行扩容在肝肾综合征中的作用一直是临床医生之间持久的争论。随着越来越多的证据表明医源性液体超负荷的有害后果，这些患者的经验性白蛋白给药已成为备受关注的焦点，最近的研究结果表明白蛋白引起肺部并发症的发生率更高。传统体检的敏感性差导致人们对使用新型无创床边工具（例如床旁超声检查 (POCUS)）更精确地评​​估血流动力学产生兴趣。诊断 POCUS 的范围一度局限于产科和急诊医学等专业，现在正在迅速扩展到其他领域，包括内科和肾病学。在此，我们根据我们的经验，就 POCUS 在客观评估疑似肝肾生理的患者方面的新兴作用提出我们的看法。我们建议未来的临床试验考虑纳入这一策略，并探讨 POCUS 指导的治疗对结果的影响。
心肾医学