Velocity Time Integral (VTI): Clinical Tips for Your Patients in Shock

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The Pre-brief

Does your patient need fluids ?

Can your patient tolerate fluids ? 

Stroke volume assessment with bedside ultrasound is a vital tool in the ICU for early diagnosis and management of shock. Stroke volume can be calculated as the product of the area of the left ventricular outflow tract (LVOT) and its Velocity time integral ( VTI ). 

As the area of the LVOT remains constant always, VTI is the most important factor influencing changes in stroke volume, and thus can be used as a surrogate. The normal LVOT VTI is 17-18cm.

The Debrief

  1. VTI can be used instead of calculating SV every time. Less time and risk for error. Some US machines do this automatically
  2.   VTI is just a number if not looking at the LV, RV, IVC, and interpreting in clinical context!
  3.   A PLR is an automatic reversible fluid bolus that can be very helpful. 
  4.   Anticipate fluid response and fluid tolerance.

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