Ultrasound Assessment of the Inferior Vena Cava for Fluid Responsiveness: Making the Case for Skepticism

2021 ◽  
pp. 088506662110241
Author(s):  
Scott J. Millington ◽  
Seth Koenig
Keyword(s):  
Inferior Vena Cava ◽  
Fluid Responsiveness ◽  
Inferior Vena ◽  
Vena Cava ◽  
Large Trial ◽  
Small Individual ◽  
Non Invasive ◽  
High Prevalence ◽  
Ultrasound Assessment ◽  
Meta Analyses

Determining whether a patient in shock is in a state of fluid responsiveness (FR) has long been the Holy Grail for clinicians who care for acutely ill patients. While various tools have been put forth as solutions to this important problem, ultrasound assessment of the inferior vena cava has received particular attention of late. Dozens of studies have examined its ability to determine whether a patient should receive volume expansion, and general enthusiasm has been strengthened by the fact that it is easy to perform and non-invasive, unlike many competing FR tests. A deeper examination of the technique, however, reveals important concerns regarding inaccuracies in measurement and a high prevalence of confounding factors. Furthermore, a detailed review of the evidence (small individual studies, multiple meta-analyses, and a single large trial) reveals that the tool performs poorly in general and is unlikely to be helpful at the bedside in circumstances where genuine clinical uncertainty exists.

Inferior vena cava collapsibility index as a predictor of fluid responsiveness in sepsis-related acute circulatory failure

2021 ◽  
Vol 13 (1) ◽  
Author(s):  
Ahmed Ibrahim Nagi ◽  
Azza Mohamed Shafik ◽  
Amr Mohamed Abdel Fatah ◽  
Wessam Zaher Selima ◽  
Amira Fathy Hefny
Keyword(s):  
Inferior Vena Cava ◽  
Fluid Responsiveness ◽  
Volume Expansion ◽  
Inferior Vena ◽  
Vena Cava ◽  
Circulatory Failure ◽  
Acute Circulatory Failure ◽  
Non Invasive ◽  
Collapsibility Index ◽  
Spontaneously Breathing

Abstract Background Assessing fluid responsiveness is the key to successful resuscitation of critically-ill sepsis patients. The use of IVC variation is favored among the dynamic methods of fluid responsiveness assessment in the ICU because it is non-invasive and inexpensive; moreover, it does not demand a high level of training. The aim of this study is to determine the value of the IVC respiratory variability for predicting fluid responsiveness in spontaneously breathing sepsis patients with acute circulatory failure. Results In this prospective observational study, fifty-eight spontaneously breathing sepsis patients admitted in the ICU were enrolled after the approval of the departmental Research Ethical Committee, and the informed written consent had been taken from the patients. Ultrasonographic and echocardiographic parameters were measured “IVC parameters and stroke volume (SV)” with calculation of the inferior vena cava collapsibility index (IVCCI) and cardiac output. These values were obtained before (baseline) and after volume expansion with a fluid bolus. The study showed that twenty-nine patients (50%) were considered to be responders, with an increase in CO by 10% or more after fluid challenge. There was a significant difference between responders and non-responders in baseline IVCCI (p value < 0.001). There were no significant differences between responders and non-responders in terms of demographic and baseline clinical characteristics. Also, there was statistically significantly larger maximum (IVC max) and minimum (IVC min) inferior vena cava diameters before volume expansion in non-responders than in responders with p value 0.037 and 0.001 respectively. The suggested cut off value regarding baseline IVCCI to predict response to fluid infusion is 0.32 with a high chance of response above this figure (a sensitivity of 72.41% and a specificity of 82.76%). Conclusions Inferior vena cava collapsibility index assessment can be a sensitive and a good predictor of fluid responsiveness, being based on a safe and a non-invasive technique compared to other methods such as central venous pressure (CVP) measurement and pulmonary artery catheter insertion.

Accuracy of Ultrasonographic Measurements of Inferior Vena Cava to Determine Fluid Responsiveness: A Systematic Review and Meta-Analysis

2018 ◽  
Vol 35 (4) ◽  
pp. 354-363 ◽  
Author(s):  
Daniele Orso ◽  
Irene Paoli ◽  
Tommaso Piani ◽  
Francesco L. Cilenti ◽  
Lorenzo Cristiani ◽  
...  
Keyword(s):  
Inferior Vena Cava ◽  
Fluid Responsiveness ◽  
Inferior Vena ◽  
Data Extraction ◽  
Meta Analysis ◽  
Vena Cava ◽  
Fluid Challenge ◽  
Area Under The Curve ◽  
Ultrasound Evaluation ◽  
Caval Index

Objective: Fluid responsiveness is the ability to increase the cardiac output in response to a fluid challenge. Only about 50% of patients receiving fluid resuscitation for acute circulatory failure increase their stroke volume, but the other 50% may worsen their outcome. Therefore, predicting fluid responsiveness is needed. In this purpose, in recent years, the assessment of the inferior vena cava (IVC) through ultrasound (US) has become very popular. The aim of our work was to systematically review all the previously published studies assessing the accuracy of the diameter of IVC or its respiratory variations measured through US in predicting fluid responsiveness. Data Sources: We searched in the MEDLINE (PubMed), Embase, Web of Science databases for all relevant articles from inception to September 2017. Study Selection: Included articles specifically addressed the accuracy of IVC diameter or its respiratory variations assessed by US in predicting the fluid responsiveness in critically ill ventilated or not, adult or pediatric patients. Data Extraction: We included 26 studies that investigated the role of the caval index (IVC collapsibility or distensibility) and 5 studies on IVC diameter. Data Synthesis: We conducted a meta-analysis for caval index with 20 studies: The pooled area under the curve, logarithmic diagnostic odds ratio, sensitivity, and specificity were 0.71 (95% confidence interval [CI]: 0.46-0.83), 2.02 (95% CI: 1.29-2.89), 0.71 (95% CI: 0.62-0.80), and 0.75 (95% CI: 0.64-0.85), respectively. Conclusion: An extreme heterogeneity of included studies was highlighted. Ultrasound evaluation of the diameter of the IVC and its respiratory variations does not seem to be a reliable method to predict fluid responsiveness.

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