Preload and fluid responsiveness

2020 ◽  
pp. 141-152
Author(s):  
Philippe Vignon
Keyword(s):  
Inferior Vena Cava ◽  
Fluid Responsiveness ◽  
Inferior Vena ◽  
Vena Cava ◽  
Ventricular Outflow Tract ◽  
Left Ventricular ◽  
Predict Fluid Responsiveness ◽  
Critical Care Echocardiography ◽  
Fluid Requirement ◽  
Passive Leg Raise

Critical care echocardiography (CCE) provides various parameters to assess fluid requirement in critically ill patients with circulatory compromise. Static parameters are based on both the measurement of the size of left ventricular cavity at end-diastole and of the inferior vena cava at end-expiration. Although low values are indicative of overt hypovolemia, static indices reflecting left ventricular preload and venous return fail to accurately predict fluid responsiveness. Accordingly, dynamic parameters based on heart–lung interactions have been validated, mostly in patients with septic shock. In mechanically ventilated patients, respiratory variations of the size of both superior and inferior vena cava, and of Doppler velocity recorded in the left ventricular outflow tract are proposed to predict fluid responsiveness. Due to their intrinsic respective limitations, these dynamic indices are complementary and can be used concomitantly according to the clinical presentation. Passive leg raise can be used in ventilated or in spontaneously breathing patients to predict fluid responsiveness. In addition, CCE accurately evaluates both the efficacy and tolerance of fluid challenges and provides a non-invasive monitoring of haemodynamics in unstable patients.

A Prospective Study of Inferior Vena Cava Parameters to Predict Fluid Responsiveness

CHEST Journal ◽  
2015 ◽  
Vol 148 (4) ◽  
pp. 506A
Author(s):  
Daniel Fein ◽  
Christopher Jordan ◽  
Samuel Acquah ◽  
Pierre Kory
Keyword(s):  
Inferior Vena Cava ◽  
Prospective Study ◽  
Fluid Responsiveness ◽  
Inferior Vena ◽  
Vena Cava ◽  
Predict Fluid Responsiveness ◽  
A Prospective Study

scholarly journals Measurement site of inferior vena cava diameter affects the accuracy with which fluid responsiveness can be predicted in spontaneously breathing patients: a post hoc analysis of two prospective cohorts

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Morgan Caplan ◽  
Arthur Durand ◽  
Perrine Bortolotti ◽  
Delphine Colling ◽  
Julien Goutay ◽  
...  
Keyword(s):  
Inferior Vena Cava ◽  
Fluid Responsiveness ◽  
Volume Expansion ◽  
Inferior Vena ◽  
Vena Cava ◽  
Predict Fluid Responsiveness ◽  
Measurement Site ◽  
Inferior Vena Cava Diameter ◽  
The Right ◽  
Spontaneously Breathing

Abstract Background The collapsibility index of the inferior vena cava (cIVC) has potential for predicting fluid responsiveness in spontaneously breathing patients, but a standardized approach for measuring the inferior vena cava diameter has yet to be established. The aim was to test the accuracy of different measurement sites of inferior vena cava diameter to predict fluid responsiveness in spontaneously breathing patients with sepsis-related circulatory failure and examine the influence of a standardized breathing manoeuvre. Results Among the 81 patients included in the study, the median Simplified Acute Physiologic Score II was 34 (24; 42). Sepsis was of pulmonary origin in 49 patients (60%). Median volume expansion during the 24 h prior to study inclusion was 1000 mL (0; 2000). Patients were not severely ill: none were intubated, only 20% were on vasopressors, and all were apparently able to perform a standardized breathing exercise. Forty-one (51%) patients were responders to volume expansion (i.e. a ≥ 10% stroke volume index increase). The cIVC was calculated during non-standardized (cIVC-ns) and standardized breathing (cIVC-st) conditions. The accuracy with which both cIVC-ns and cIVC-st predicted fluid responsiveness differed significantly by measurement site (interaction p < 0.001 and < 0.0001, respectively). Measuring inferior vena cava diameters 4 cm caudal to the right atrium predicted fluid responsiveness with the best accuracy. At this site, a standardized breathing manoeuvre also significantly improved predictive power: areas under ROC curves [mean and (95% CI)] for cIVC-ns = 0.85 [0.78–0.94] versus cIVC-st = 0.98 [0.97–1.0], p < 0.001. When cIVC-ns is superior or equal to 33%, fluid responsiveness is predicted with a sensitivity of 66% and a specificity of 92%. When cIVC-st is superior or equal to 44%, fluid responsiveness is predicted with a sensitivity of 93% and a specificity of 98%. Conclusion The accuracy with which cIVC measurements predict fluid responsiveness in spontaneously breathing patients depends on both the measurement site of inferior vena cava diameters and the breathing regime. Measuring inferior vena cava diameters during a standardized inhalation manoeuvre at 4 cm caudal to the right atrium seems to be the method by which to obtain cIVC measurements best-able to predict patients’ response to volume expansion.

scholarly journals Respiratory variations of inferior vena cava fail to predict fluid responsiveness in mechanically ventilated patients with isolated left ventricular dysfunction

2019 ◽  
Vol 9 (1) ◽  
Author(s):  
Hongmin Zhang ◽  
◽  
Qing Zhang ◽  
Xiukai Chen ◽  
Xiaoting Wang ◽  
...  
Keyword(s):  
Inferior Vena Cava ◽  
Fluid Responsiveness ◽  
Roc Analysis ◽  
Inferior Vena ◽  
Left Ventricular Systolic Dysfunction ◽  
Systolic Dysfunction ◽  
Vena Cava ◽  
Left Ventricular ◽  
Mechanically Ventilated ◽  
Controlled Mechanical Ventilation

Abstract Background Respiratory variation of inferior vena cava is problematic in predicting fluid responsiveness in patients with right ventricular dysfunction. However, its effectiveness in patients with isolated left ventricular systolic dysfunction (ILVD) has not been reported. We aimed to explore whether inferior vena cava diameter distensibility index (dIVC) can predict fluid responsiveness in mechanically ventilated ILVD patients. Methods Patients admitted to the intensive care unit who were on controlled mechanical ventilation and in need of a fluid responsiveness assessment were screened for enrolment. Several echocardiographic parameters, including dIVC, tricuspid annular plane systolic excursion (TAPSE), left ventricular ejection fraction (LVEF), and LV outflow tract velocity–time integral (VTI) before and after passive leg raising (PLR) were collected. Patients with LV systolic dysfunction only (TAPSE ≥ 16 mm, LVEF < 50%) were considered to have isolated left ventricular systolic dysfunction (ILVD). Results One hundred and twenty-nine subjects were enrolled in this study, among them, 28 were labelled ILVD patients, and the remaining 101 were patients with normal LV function (NLVF). The value of dIVC in ILVD patients was as high as that in NLVF patients, (20% vs. 16%, p = 0.211). The ILVD group contained a much lower proportion of PLR responders than NLVF patients did (17.9% vs. 53.2%, p < 0.001). No correlation was detected between dIVC and ΔVTI in ILVD patients (r = 0.196, p = 0.309). dIVC was correlated with ΔVTI in NLVF patients (r = 0.722, p < 0.001), and the correlation was strengthened compared with that derived from all patients (p = 0.020). A receiver-operating characteristic (ROC) analysis showed that the area-under-the-curve (AUC) of dIVC for determining fluid responsiveness from ILVD patients was not statistically significant (p = 0.251). In NLVF patients, ROC analysis revealed an AUC of 0.918 (95% CI 0.858–0.978; p < 0.001), which was higher than the AUC derived from all patients (p = 0.033). Patients with LVEF below 40% had a lower ΔVTI and fewer PLR responders than those with LVEF 40–50% and LVEF above 50% (p < 0.001). Conclusion dIVC should be used with caution when critically ill patients on controlled mechanical ventilation display normal right ventricular function in combination with abnormal left ventricular systolic function.

Comparison between respiratory changes in the inferior vena cava diameter and pulse pressure variation to predict fluid responsiveness in postoperative patients

2016 ◽  
Vol 34 ◽  
pp. 46-49 ◽  
Author(s):  
Olivia Haun de Oliveira ◽  
Flávio Geraldo Rezende de Freitas ◽  
Renata Teixeira Ladeira ◽  
Claudio Henrique Fischer ◽  
Antônio Tonete Bafi ◽  
...  
Keyword(s):  
Inferior Vena Cava ◽  
Fluid Responsiveness ◽  
Pulse Pressure ◽  
Pulse Pressure Variation ◽  
Inferior Vena ◽  
Vena Cava ◽  
Pressure Variation ◽  
Predict Fluid Responsiveness ◽  
Inferior Vena Cava Diameter
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