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.

scholarly journals Distensibility Index of Inferior Vena Cava and Pulse Pressure Variation as Predictors of Fluid Responsiveness in Mechanically Ventilated Shocked Patients

2020 ◽  
Vol 2020 (1) ◽  
Author(s):  
Wo'oud Mohiedden Mohammad Abdelfattah ◽  
Sahar Saad-eldeen Elgammal ◽  
Khaled Mohammad Elsayed ◽  
Sherif Mohammad Said Mowafy ◽  
Radwa Mohammad Abdalla
Keyword(s):  
Inferior Vena Cava ◽  
Fluid Responsiveness ◽  
Pulse Pressure ◽  
Pulse Pressure Variation ◽  
Inferior Vena ◽  
Vena Cava ◽  
Pressure Variation ◽  
Mechanically Ventilated

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.

scholarly journals Respiratory variation of inferior vena cava diameter and central venous pressure in ventilated and non-ventilated children in fluid refractory septic shock: an observational study

2019 ◽  
Vol 6 (5) ◽  
pp. 1947
Author(s):  
Mohd Kashif Ali ◽  
Eeman Naim
Keyword(s):  
Septic Shock ◽  
Inferior Vena Cava ◽  
Central Venous Pressure ◽  
Inferior Vena ◽  
Venous Pressure ◽  
Vena Cava ◽  
Central Venous ◽  
Mechanically Ventilated ◽  
Spontaneously Breathing ◽  
Ventilated Patients

Background: Ultrasound guided fluid assessment in management of septic shock has come up as an adjunct to the current gold standard Central Venous Pressure monitoring. This study was designed to observe the respiro-phasic variation of IVC diameter (RV-IVCD) in invasively mechanically ventilated and spontaneously breathing paediatric patients of fluid refractory septic shock.Methods: This was a prospective observational study done at Paediatric intensive Care Unit (PICU) in Paediatric ward of Jawaharlal Nehru Medical College and Hospital (JNMCH) from February 2016 to June 2017. 107 consecutive patients between 1 year to 16 years age who were in shock despite 40ml/kg of fluid administration were included. Inferior Vena Cava (IVC) diameters were measured at end-expiration and end inspiration and the IVC collapsibility index was calculated. Simultaneously Central Venous Pressure (CVP) was recorded. Both values were obtained in ventilated and non-ventilated patients. Data was analysed to determine to look for the profile of RV-IVCD and CVP in ventilated and non-ventilated cases.Results: Out of 107 patients, 91 were on invasive mechanical ventilation and 16 patients were spontaneously breathing. There was a strong negative correlation between central venous pressure (CVP) and inferior vena cava collapsibility (RV-IVCD) in both spontaneously breathing (-0.810) and mechanically ventilated patients (-0.700). Negative correlation was significant in both study groups in CVP <8 mmHg and only in spontaneously breathing patients in CVP 8-12 mmHg range. IVC collapsibility showed a decreasing trend with rising CVP in both spontaneously breathing and mechanically ventilated patients.Conclusion: Ultrasonography guided IVCCI appears to be a valuable index in assessing fluid status in both spontaneously breathing and mechanically ventilated septic shock patients. However, more data is required from the paediatric population so as to define it as standard of practice.

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