Development of a fluid resuscitation protocol using inferior vena cava and lung ultrasound

Objective: Fluid resuscitation is necessary in almost all critical patients. The central venous pressure (CVP) is a well-established method of assessing resuscitation. Recently, there have been attempts to investigate less invasive methods like the diameters of inferior vena cava (IVC) or the jugular vein. We aimed to investigate this method in our research. Methods: Seventy eight critical patients admitted to the emergency department from April 2018 to December 2018 were studied. The CVP was measured along with the diameters of the two mentioned veins before and during resuscitation. The urinary output was also recorded after administering the fluid. The minimum p-value that would illustrate a significant association was equal to 0.05. Results: Findings showed that 53.8% of patients were males and 46.2% were females with an average age of 71.48 years. The causes of the critical state were 25.6% hemorrhagic shocks, 30.8% septic shocks and 43.6% hypovolemic shocks. The mean diameter of the jugular vein before and during resuscitation was 27.21 mm and 25.38 mm, respectively (P=0.1). The mean of IVC diameter before and during resuscitation was 63.33 mm and 57.98 mm, respectively (P <0.001). The CVP was 4.23 mmHg before resuscitation and 5.61 mmHg after resuscitation (P <0.001). With an average urine output of 201.28 cc, a significant correlation was observed with the increase in the CVP, while no such correlations were observed with the decreasing state of the diameters of the IVC or the jugular vein. Conclusion: Both the IVC diameter and the jugular vein diameter are unable to assess fluid resuscitation independently from respiratory factors.

Download Full-text

Ultrasound Evaluation of the Respiratory Variations of the Internal Jugular Vein Compared to the Respiratory Variations of the Inferior Vena Cava as a Guidance of Fluid Responsiveness in Septic Shock

QJM ◽

10.1093/qjmed/hcab086.003 ◽

2021 ◽

Vol 114 (Supplement_1) ◽

Author(s):

Ahmed Abd Elalim Ali Khalil ◽

. Galal Adel Mohamed Elkadi ◽

Sherif George Anies Saeid ◽

Gamal Eldin Adel Abd Elhameed Saleh

Keyword(s):

Intensive Care Unit ◽

Septic Shock ◽

Intensive Care ◽

Inferior Vena Cava ◽

Fluid Responsiveness ◽

Internal Jugular Vein ◽

Fluid Resuscitation ◽

Inferior Vena ◽

Jugular Vein ◽

Vena Cava

Abstract Background Septic shock is one of the most complex hemodynamic failure syndromes. It is the major cause of mortality and morbidity in intensive care unit. Fluid resuscitation is of paramount importance in septic shock. However, its correction should be carefully guided to avoid unnecessary volume expansion. Ultra- sonographic evaluation of fluid responsiveness plays an important role in septic shock. Objectives The objective of the study was to verify the feasibility and usefulness of the internal jugular vein distensibility index in prediction of fluid responsiveness in septic shock patients undergoing mechanical ventilation compared to the inferior vena cava distensibility index. Methodology The study was carried out in Ain Shams University Hospital from February 2019 to November 2019, on twenty patients 20 patients of both sex who were admitted to the intensive care unit and diagnosed as septic shock (sepsisinduced hypotension persisting despite adequate fluid resuscitation and require vasopressors and serum lactate > 2 mmol/ L) As regard the hemodynamic parameters, patients were classified into two groups: Fluid responders and non-fluid responders. Results The study demonstrated that there was a positive correlation between internal jugular vein distensibility index (IJV DI) and inferior vena cava distensibility index (IVC DI) in prediction of fluid responsiveness. IVC DI index cutoff value was > 12.6% with sensitivity 80% and specificity 80% and IJV DI cut off value was >8.4% with sensitivity 86.67% and specificity 80%. Conclusion ultra-sonographic assessment of the internal jugular vein distensibility index (IJV DI) and inferior vena cava distensibility index (IVC DI) are useful dynamic indices in assessment of the intravascular volume state in mechanically ventilated septic shock patients. IJV and IVC show comparable value in the prediction of fluid responsiveness.

Download Full-text

Comparison between inferior vena cava ultrasound, lung ultrasound, bioelectric impedance analysis, and natriuretic peptides in chronic heart failure

Current Medical Research and Opinion ◽

10.1080/03007995.2018.1519502 ◽

2018 ◽

Vol 35 (4) ◽

pp. 705-713 ◽

Cited By ~ 8

Author(s):

Jose Curbelo ◽

Pablo Rodriguez-Cortes ◽

Maria Aguilera ◽

Paloma Gil-Martinez ◽

Daniel Martín ◽

...

Keyword(s):

Heart Failure ◽

Chronic Heart Failure ◽

Inferior Vena Cava ◽

Natriuretic Peptides ◽

Inferior Vena ◽

Lung Ultrasound ◽

Vena Cava ◽

Impedance Analysis ◽

Bioelectric Impedance Analysis ◽

Bioelectric Impedance

Download Full-text

Diagnostic performances of lung ultrasound associated with inferior vena cava assessment for the diagnosis of acute heart failure in elderly emergency patients

European Journal of Emergency Medicine ◽

10.1097/mej.0000000000000759 ◽

2020 ◽

Vol Publish Ahead of Print ◽

Author(s):

Frederic Balen ◽

Charles-Henri Houze Cerfon ◽

Dominique Lauque ◽

Manon Hebrad ◽

Thibault Legourrierec ◽

...

Keyword(s):

Heart Failure ◽

Inferior Vena Cava ◽

Acute Heart Failure ◽

Inferior Vena ◽

Lung Ultrasound ◽

Vena Cava ◽

Emergency Patients

Download Full-text

Role of Point of Care Ultra Sound (POCUS) in Assessment of Fluid Resuscitation in Septic Patients

Journal of Advances in Medicine and Medical Research ◽

10.9734/jammr/2021/v33i2031127 ◽

2021 ◽

pp. 242-248

Author(s):

Sohier Fouad ◽

Nagat Elshamaa ◽

Ghada El-Baradey ◽

Hala Elgendy

Keyword(s):

Inferior Vena Cava ◽

Fluid Resuscitation ◽

Inferior Vena ◽

Arterial Oxygen Saturation ◽

Isotonic Saline ◽

Vena Cava ◽

Arterial Oxygen ◽

Ultra Sound ◽

Patient Arrival ◽

Caval Index

Background: Initial fluid resuscitation in sepsis must be guided by clinical judgment based on ongoing reevaluation of the hemodynamic status (heart rate, blood pressure, arterial oxygen saturation, respiratory rate, temperature, urine output) and ultrasound measurements (stroke volume, cardiac output, lung ultrasound and inferior vena cava diameter) as positive fluid balance is harmful. Methods: Adults Patients (≥ 18 years old) with symptoms or signs of tissue hypoperfusion (Sequential organ failure assessment score SOFA≥ 2) are included. Patients with elevated intra-abdominal pressure (as, ascites, pregnancy), Recent abdominal operation, cannot lie flat, Patient on mechanical ventilation and patients with valvular heart disease were excluded. IVC CI, SV, COP and B mean score were measured on patient arrival and after every 10 ml/kg isotonic saline over the first hour of patient arrival. Thereafter, patients were divided into two groups high caval index and low caval index according to inferior vena cava collapsibility index. Results: Among our 50 patients,38% of patients were with high caval index and 62% have low caval index. Conclusion: POCUS has additive value in guiding of fluid resuscitation in sepsis in order to avoid fluid overload and to identify proper timing of vasopressor use.

Download Full-text