scholarly journals Meta-Analysis of Ventilated versus Spontaneously Breathing Patients in Predicting Fluid Responsiveness by Inferior Vena Cava Variation

2018 ◽  
Vol 09 (10) ◽  
pp. 760-777 ◽  
Author(s):  
Xiang Si ◽  
Daiyin Cao ◽  
Hailin Xu ◽  
Xiangdong Guan
Keyword(s):  
Inferior Vena Cava ◽  
Fluid Responsiveness ◽  
Inferior Vena ◽  
Meta Analysis ◽  
Vena Cava ◽  
Spontaneously Breathing

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.

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.

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.

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 Performance of a 25% Inferior Vena Cava Collapsibility in Detecting Fluid Responsiveness When Assessed by Novice Versus Expert Physician Sonologists

2019 ◽  
Vol 35 (12) ◽  
pp. 1520-1528
Author(s):  
Keith A. Corl ◽  
Nader Azab ◽  
Mohammed Nayeemuddin ◽  
Alexandra Schick ◽  
Thomas Lopardo ◽  
...  
Keyword(s):  
Inferior Vena Cava ◽  
Fluid Responsiveness ◽  
Inferior Vena ◽  
Characteristic Curve ◽  
Vena Cava ◽  
Point Of Care Ultrasound ◽  
Icu Patients ◽  
Cutoff Value ◽  
Spontaneously Breathing ◽  
Expert Physician

Objectives: Inferior vena cava collapsibility (cIVC) measured by point-of-care ultrasound (POCUS) has been proposed as a noninvasive means of assessing fluid responsiveness. We aimed to prospectively evaluate the performance of a 25% cIVC cutoff value to detect fluid responsiveness among spontaneously breathing intensive care unit (ICU) patients when assessed with POCUS by novice versus expert physician sonologists. Methods: Prospective observational study of spontaneously breathing ICU patients. Fluid responsiveness was defined as a >10% increase in cardiac index following a 500 mL fluid bolus, measured by bioreactance. Novice sonologist measured cIVC with POCUS. Their measurements were later compared to an expert physician sonologist who independently reviewed the POCUS images and assessed cIVCs. Results: Of the 85 participants, 44 (52%) were fluid responders. A 25% cIVC cutoff value performed better when assessed by expert sonologists than novice physician sonologists (receiver–operator characteristic curve, ROC = 0.82 [0.74-0.88] vs ROC = 0.69 [0.60-0.77]). Conclusions: A 25% cIVC cutoff value measured by POCUS detects fluid responsiveness. However, the experience of the physician sonologist affects test performance and should be considered when interpreting and clinically using cIVC to direct intravenous fluid resuscitation.

scholarly journals Does inferior vena cava respiratory variability predict fluid responsiveness in spontaneously breathing patients?

Critical Care ◽  
2015 ◽  
Vol 19 (1) ◽  
Author(s):  
Norair Airapetian ◽  
Julien Maizel ◽  
Ola Alyamani ◽  
Yazine Mahjoub ◽  
Emmanuel Lorne ◽  
...  
Keyword(s):  
Inferior Vena Cava ◽  
Fluid Responsiveness ◽  
Inferior Vena ◽  
Vena Cava ◽  
Predict Fluid Responsiveness ◽  
Spontaneously Breathing ◽  
Respiratory Variability
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