scholarly journals Role of Point of Care Ultra Sound (POCUS) in Assessment of Fluid Resuscitation in Septic Patients

2021 ◽  
pp. 242-248
Author(s):  
Sohier Fouad ◽  
Nagat Elshamaa ◽  
Ghada El-Baradey ◽  
Hala Elgendy
Keyword(s):  
Inferior Vena Cava ◽  
Fluid Resuscitation ◽  
Inferior Vena ◽  
Arterial Oxygen Saturation ◽  
Isotonic Saline ◽  
Vena Cava ◽  
Arterial Oxygen ◽  
Ultra Sound ◽  
Patient Arrival ◽  
Caval Index

Background: Initial fluid resuscitation in sepsis must be guided by clinical judgment based on ongoing reevaluation of the hemodynamic status (heart rate, blood pressure, arterial oxygen saturation, respiratory rate, temperature, urine output) and ultrasound measurements (stroke volume, cardiac output, lung ultrasound and inferior vena cava diameter) as positive fluid balance is harmful. Methods: Adults Patients (≥ 18 years old) with symptoms or signs of tissue hypoperfusion (Sequential organ failure assessment score SOFA≥ 2) are included. Patients with elevated intra-abdominal pressure (as, ascites, pregnancy), Recent abdominal operation, cannot lie flat, Patient on mechanical ventilation and patients with valvular heart disease were excluded. IVC CI, SV, COP and B mean score were measured on patient arrival and after every 10 ml/kg isotonic saline over the first hour of patient arrival. Thereafter, patients were divided into two groups high caval index and low caval index according to inferior vena cava collapsibility index. Results: Among our 50 patients,38% of patients were with high caval index and 62% have low caval index. Conclusion: POCUS has additive value in guiding of fluid resuscitation in sepsis in order to avoid fluid overload and to identify proper timing of vasopressor use.

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.

Increased pulmonary vascular resistance and reduced stroke volume in association with CO2retention and inferior vena cava dilatation

2006 ◽  
Vol 101 (3) ◽  
pp. 866-872 ◽  
Author(s):  
Darija Baković ◽  
Davor Eterović ◽  
Zoran Valic ◽  
Žana Saratlija-Novaković ◽  
Ivan Palada ◽  
...  
Keyword(s):  
Cardiac Output ◽  
Inferior Vena Cava ◽  
Pulmonary Vascular Resistance ◽  
Vascular Resistance ◽  
Inferior Vena ◽  
Vena Cava ◽  
Arterial Oxygen ◽  
Breath Holding ◽  
Oxygen Saturation Level ◽  
The Impact

Changes in cardiovascular parameters elicited during a maximal breath hold are well described. However, the impact of consecutive maximal breath holds on central hemodynamics in the postapneic period is unknown. Eight trained apnea divers and eight control subjects performed five successive maximal apneas, separated by a 2-min resting interval, with face immersion in cold water. Ultrasound examinations of inferior vena cava (IVC) and the heart were carried out at times 0, 10, 20, 40, and 60 min after the last apnea. The arterial oxygen saturation level and blood pressure, heart rate, and transcutaneous partial pressures of CO2and O2were monitored continuously. At 20 min after breath holds, IVC diameter increased (27.6 and 16.8% for apnea divers and controls, respectively). Subsequently, pulmonary vascular resistance increased and cardiac output decreased both in apnea divers (62.8 and 21.4%, respectively) and the control group (74.6 and 17.8%, respectively). Cardiac output decrements were due to reductions in stroke volumes in the presence of reduced end-diastolic ventricular volumes. Transcutaneous partial pressure of CO2increased in all participants during breath holding, returned to baseline between apneas, but remained slightly elevated during the postdive observation period (∼4.5%). Thus increased right ventricular afterload and decreased cardiac output were associated with CO2retention and signs of peripheralization of blood volume. These results indicate that repeated apneas may cause prolonged hemodynamic changes after resumption of normal breathing, which may suggest what happens in sleep apnea syndrome.

Inferior vena cava guided fluid resuscitation – Fact or fiction?

2015 ◽  
Vol 5 (2-3) ◽  
pp. 70-75 ◽  
Author(s):  
Hon Liang Tan ◽  
Olivia Wijeweera ◽  
James Onigkeit
Keyword(s):  
Inferior Vena Cava ◽  
Fluid Resuscitation ◽  
Inferior Vena ◽  
Vena Cava

Development of a fluid resuscitation protocol using inferior vena cava and lung ultrasound

2016 ◽  
Vol 31 (1) ◽  
pp. 96-100 ◽  
Author(s):  
Christopher W.C. Lee ◽  
Pierre D. Kory ◽  
Robert T. Arntfield
Keyword(s):  
Inferior Vena Cava ◽  
Fluid Resuscitation ◽  
Inferior Vena ◽  
Lung Ultrasound ◽  
Vena Cava

scholarly journals The efficacy of inferior vena cava diameters and the jugular vein in assessing fluid resuscitation

2019 ◽  
Vol 5 (2) ◽  
pp. 61-64
Author(s):  
Nahid Zamanimehr ◽  
Samad Shams Vahdati ◽  
Hamed Hojjatpanah
Keyword(s):  
Inferior Vena Cava ◽  
Fluid Resuscitation ◽  
Inferior Vena ◽  
Jugular Vein ◽  
Venous Pressure ◽  
Vena Cava ◽  
P Value ◽  
The Mean ◽  
Critical Patients ◽  
Almost All

Objective: Fluid resuscitation is necessary in almost all critical patients. The central venous pressure (CVP) is a well-established method of assessing resuscitation. Recently, there have been attempts to investigate less invasive methods like the diameters of inferior vena cava (IVC) or the jugular vein. We aimed to investigate this method in our research. Methods: Seventy eight critical patients admitted to the emergency department from April 2018 to December 2018 were studied. The CVP was measured along with the diameters of the two mentioned veins before and during resuscitation. The urinary output was also recorded after administering the fluid. The minimum p-value that would illustrate a significant association was equal to 0.05. Results: Findings showed that 53.8% of patients were males and 46.2% were females with an average age of 71.48 years. The causes of the critical state were 25.6% hemorrhagic shocks, 30.8% septic shocks and 43.6% hypovolemic shocks. The mean diameter of the jugular vein before and during resuscitation was 27.21 mm and 25.38 mm, respectively (P=0.1). The mean of IVC diameter before and during resuscitation was 63.33 mm and 57.98 mm, respectively (P <0.001). The CVP was 4.23 mmHg before resuscitation and 5.61 mmHg after resuscitation (P <0.001). With an average urine output of 201.28 cc, a significant correlation was observed with the increase in the CVP, while no such correlations were observed with the decreasing state of the diameters of the IVC or the jugular vein. Conclusion: Both the IVC diameter and the jugular vein diameter are unable to assess fluid resuscitation independently from respiratory factors.

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 &gt; 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 &gt; 12.6% with sensitivity 80% and specificity 80% and IJV DI cut off value was &gt;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.

scholarly journals Accuracy of the caval index and the expiratory diameter of the inferior vena cava for the diagnosis of dehydration in elderly

2016 ◽  
Vol 19 (3) ◽  
pp. 203-209 ◽  
Author(s):  
Daniele Orso ◽  
Nicola Guglielmo ◽  
Nicola Federici ◽  
Francesco Cugini ◽  
Alessio Ban ◽  
...  
Keyword(s):  
Inferior Vena Cava ◽  
Inferior Vena ◽  
Vena Cava ◽  
Caval Index

scholarly journals P892 Accuracy of right atrial pressure estimation using a multi-parameter approach derived from Inferior vena cava semi-automated edge-tracking echocardiography

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
S Albani ◽  
B Pinamonti ◽  
M De Scordilli ◽  
E Fabris ◽  
A Perkan ◽  
...  
Keyword(s):  
Inferior Vena Cava ◽  
Inferior Vena ◽  
Ventricular Dysfunction ◽  
Vena Cava ◽  
Atrial Pressure ◽  
Right Atrial ◽  
Right Atrial Pressure ◽  
Edge Tracking ◽  
Automatic Technique ◽  
Caval Index

Abstract Background In clinical practice, as stated in the ASE guidelines, the echocardiographic estimation of right atrial pressure (RAP) is based on the size of the inferior vena cava (IVC) and its inspiratory collapse. However, this method has proven to have limits of reliability and reproducibility. The use of a recently developed software that with a semi-automatic technique highlight the edges of the IVC could help to standardize the echocardiographic assessment of RAP. Aim of the study: The aim of the study was to assess feasibility and accuracy of a new semi-automated approach to estimate the RAP. Standard acquired echocardiographic images were processed with a semi-automatic technique, indexes related to the collapsibility of the vessel during inspiration (Caval Index, CI), during the whole respiratory cycle (Respiratory Caval Index, RCI) and through the heart cycle transmitted movements’ (Cardiac Caval Index (CCI) were derived (figure 1). Using these indexes, we developed two models: a) the Binary Tree Model (BTM), further divided in BTM3 and BTM5 (RAP estimated in 3 and 5 classes, respectively); b) the Regression Model (RM), further divided in RM linear (continuous model) and RM3 and RM5 (RAP estimated in 3 and 5 classes respectively). RAP assessed using these innovative techniques were compared with two standard estimation (SE) echocardiographic methods A and B. Direct RAP measurements obtained during a right heart catheterization (RHC), performed within 6 hours, were used as reference. Results 62 consecutive ‘all-comers’ patients that had a RHC were enrolled; 13 patients were excluded for technical reasons. Therefore 49 patients were included in this study (26 males and 23 females; mean age of 62.2 ± 15.2 years, 75.5% pulmonary hypertension, 34.7% severe left ventricular dysfunction and 51% right ventricular dysfunction). The two SE methods showed poor accuracy for RAP estimation (method A: ME = 51%, R2= 0.22; method B: ME = 69%, R2= 0.26). Instead, the new semi-automatic methods BTM3 and BTM5 based on parameters derived from IVC edge tracking (mean IVC diameter, CI, CCI and RCI) had a misclassification error of only 14% (R2 = 0.47) and 22% (R2 = 0.61), respectively, to classify RAP. The accuracy was lower for RM than BTM (RM3: ME = 61%, R2 = 0.39; RM5: ME = 55%, R2 = 0.39). However, the RM showed the lowest mean bias in estimating RAP: 0.23 [-8.34; 8.81] mmHg. Conclusions A multi-parametric approach using the new indexes, such as CCI and RCI, derived from a semi-automated edge tracking of the IVC is a promising tool for a more accurate estimation of RAP. This study proposes an innovative method for the non-invasive estimation of the RAP, which requires confirmation on larger population. Abstract P892 Figure 1

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