scholarly journals Predicting and measuring fluid responsiveness with echocardiography

2016 ◽  
Vol 3 (2) ◽  
pp. G1-G12 ◽  
Author(s):  
Ashley Miller ◽  
Justin Mandeville
Keyword(s):  
Left Ventricle ◽  
Inferior Vena Cava ◽  
Right Ventricle ◽  
Fluid Responsiveness ◽  
Fluid Resuscitation ◽  
Critically Ill Patients ◽  
Inferior Vena ◽  
Vena Cava ◽  
Clinical Judgement ◽  
Dynamic Variables

Echocardiography is ideally suited to guide fluid resuscitation in critically ill patients. It can be used to assess fluid responsiveness by looking at the left ventricle, aortic outflow, inferior vena cava and right ventricle. Static measurements and dynamic variables based on heart–lung interactions all combine to predict and measure fluid responsiveness and assess response to intravenous fluid resuscitation. Thorough knowledge of these variables, the physiology behind them and the pitfalls in their use allows the echocardiographer to confidently assess these patients and in combination with clinical judgement manage them appropriately.

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 ◽  
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.

Inferior vena cava collapsibility detects fluid responsiveness among spontaneously breathing critically-ill patients

2017 ◽  
Vol 41 ◽  
pp. 130-137 ◽  
Author(s):  
Keith A. Corl ◽  
Naomi R. George ◽  
Justin Romanoff ◽  
Andrew T. Levinson ◽  
Darin B. Chheng ◽  
...  
Keyword(s):  
Inferior Vena Cava ◽  
Critically Ill ◽  
Fluid Responsiveness ◽  
Critically Ill Patients ◽  
Inferior Vena ◽  
Vena Cava ◽  
Spontaneously Breathing

scholarly journals Plethysmographic variability index as a tool to assess fluid responsiveness in critically ill patients: a correlation study with inferior vena cava distensibility index

2019 ◽  
Vol 7 (12) ◽  
pp. 4663
Author(s):  
Parvinder Singh Bedi ◽  
Bhavna Pahwa ◽  
Bhavna Hooda ◽  
Deepak Dwivedi
Keyword(s):  
Inferior Vena Cava ◽  
Critically Ill ◽  
Fluid Responsiveness ◽  
Critically Ill Patients ◽  
Inferior Vena ◽  
Vena Cava ◽  
Fluid Challenge ◽  
Time Points ◽  
Variability Index ◽  
Plethysmographic Variability Index

Background: In critically ill patients in the intensive care unit (ICU), early aggressive fluid replacement is the cornerstone of resuscitation. Traditionally employed static measures of fluid responsiveness have a poor predictive value. It is therefore imperative to employ dynamic measures of fluid responsiveness that take into account the heart lung interactions in the mechanically ventilated patients. The main objective of this study was to evaluate the reliability of one such non-invasive dynamic index: Plethysmographic variability index (PVI) compared to the widely employed Inferior vena cava distensibility index (dIVC).Methods: Seventy-six adult patients admitted at a tertiary care mixed ICU, who developed hypotension (MAP<65mmHg), were included in the study. PVI was recorded using the MASIMO-7 monitor and dIVC measurements done using Terason ultrasound. Based on the dIVC measurement threshold of 18%, the patients were classified into volume responders and non-responders. The hemodynamic, PVI and dIVC measurements were recorded at pre specified time points following a fluid challenge of 20 ml/kg crystalloid infusion.Results: Baseline PVI values were significantly higher in the responders (22.3±8.2) compared to non-responders (10.1±2.9) (p<0.001) and showed a declining trend at all time points in the responders. Similar declining trend was observed in the dIVC measurements. Overall, the Pearson correlation graph showed strong correlation between dIVC and PVI values at all time points (r=0.678, p=0.001). The ROC curve between the dIVC and PVI values revealed that Baseline PVI (Pre PVI) >15.5% discriminated between responders and non-responders with a 90.2% sensitivity and 75% specificity with an AUC of 0.84 (0.72-0.96) (p<0.001).Conclusions: There is good correlation between PVI values and measured dIVC values at baseline and following a fluid challenge. Thus, PVI may be an acceptable, real time, continuous, surrogate measure of fluid responsiveness in critically ill patients.

scholarly journals Semi-automatic Algorithms for Estimation and Tracking of AP-diameter of the IVC in Ultrasound Images

2018 ◽  
Author(s):  
Ebrahim Karami ◽  
Mohamed Shehata ◽  
Andrew Smith
Keyword(s):  
Inferior Vena Cava ◽  
Medical Research ◽  
Fluid Resuscitation ◽  
Critically Ill Patients ◽  
Inferior Vena ◽  
Vena Cava ◽  
Ultrasound Images ◽  
Manual Measurement ◽  
Circle Model ◽  
Anterior Posterior

Medical research has suggested that the anterior-posterior (AP)-diameter of the inferior vena cava (IVC) and its associated temporal variation as imaged by bedside ultrasound is useful in guiding fluid resuscitation of the critically-ill patients. This paper develops semi-automatic active ellipse and rectangle algorithms for measurement and tracking of the AP-diameter. The proposed algorithms are compared with an expert manual measurement and the previous work based on active circle model. It is shown that regardless of the shape of the IVC, the rectangle model always outperforms the two other models and performs very close to manual measurement.

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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