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

Airapetian N, Maizel J, Alyamani O, Mahjoub Y, Lorne E, Levrard M, Ammenouche N, Seydi A, Tinturier F, Lobjoie E, Dupont H, Slama M - Crit Care (2015)

Bottom Line: There were no significant differences between responders and nonresponders at baseline, except for a higher aortic VTI in nonresponders (16 cm vs. 19 cm, p = 0.03).Prediction of fluid-responsiveness using cIVC and IVCmax was low (area under the curve for cIVC at baseline 0.62 ± 0.07; 95 %, CI 0.49-0.74 and for IVCmax at baseline 0.62 ± 0.07; 95 % CI 0.49-0.75).In SBP with suspected hypovolemia, vena cava size and respiratory variability do not predict fluid responsiveness.

View Article: PubMed Central - PubMed

Affiliation: Intensive Care Unit, Department of Nephrology, Amiens University Medical Center, 80054, Cedex 1, Amiens, France. airapetian.norair@chu-amiens.fr.

ABSTRACT

Introduction: We have almost no information concerning the value of inferior vena cava (IVC) respiratory variations in spontaneously breathing ICU patients (SBP) to predict fluid responsiveness.

Methods: SBP with clinical fluid need were included prospectively in the study. Echocardiography and Doppler ultrasound were used to record the aortic velocity-time integral (VTI), stroke volume (SV), cardiac output (CO) and IVC collapsibility index (cIVC) ((maximum diameter (IVCmax)- minimum diameter (IVCmin))/ IVCmax) at baseline, after a passive leg-raising maneuver (PLR) and after 500 ml of saline infusion.

Results: Fifty-nine patients (30 males and 29 females; 57 ± 18 years-old) were included in the study. Of these, 29 (49 %) were considered to be responders (≥10 % increase in CO after fluid infusion). There were no significant differences between responders and nonresponders at baseline, except for a higher aortic VTI in nonresponders (16 cm vs. 19 cm, p = 0.03). Responders had a lower baseline IVCmin than nonresponders (11 ± 5 mm vs. 14 ± 5 mm, p = 0.04) and more marked IVC variations (cIVC: 35 ± 16 vs. 27 ± 10 %, p = 0.04). Prediction of fluid-responsiveness using cIVC and IVCmax was low (area under the curve for cIVC at baseline 0.62 ± 0.07; 95 %, CI 0.49-0.74 and for IVCmax at baseline 0.62 ± 0.07; 95 % CI 0.49-0.75). In contrast, IVC respiratory variations >42 % in SBP demonstrated a high specificity (97 %) and a positive predictive value (90 %) to predict an increase in CO after fluid infusion.

Conclusions: In SBP with suspected hypovolemia, vena cava size and respiratory variability do not predict fluid responsiveness. In contrast, a cIVC >42 % may predict an increase in CO after fluid infusion.

No MeSH data available.


Related in: MedlinePlus

Receiver operating characteristic curves for discriminating between volume expansion responders and nonresponders. ∆CO change in CO between baseline and after PLR, VCmax maximum inferior vena cava diameter at baseline, cIVC inferior vena cava collapsibility index at baseline, PLR passive leg raising
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Fig1: Receiver operating characteristic curves for discriminating between volume expansion responders and nonresponders. ∆CO change in CO between baseline and after PLR, VCmax maximum inferior vena cava diameter at baseline, cIVC inferior vena cava collapsibility index at baseline, PLR passive leg raising

Mentions: The only significant correlation was between changes in CO during PLR challenge and changes in CO after volume expansion (r = 0.69, p = 0.0001). None of the other variables were correlated with CO changes after volume expansion (Table 4). The highest AUC values were found for ΔCO (0.78 ± 0.06; 95 % confidence interval (CI) [0.66-0.88], cIVC at baseline (0.62 ± 0.07; 95 %CI 0.49-0.74) and IVCmax at baseline (0.62 ± 0.07; 95 %CI 0.49-0.75) (Table 4, Fig. 1).Table 4


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

Airapetian N, Maizel J, Alyamani O, Mahjoub Y, Lorne E, Levrard M, Ammenouche N, Seydi A, Tinturier F, Lobjoie E, Dupont H, Slama M - Crit Care (2015)

Receiver operating characteristic curves for discriminating between volume expansion responders and nonresponders. ∆CO change in CO between baseline and after PLR, VCmax maximum inferior vena cava diameter at baseline, cIVC inferior vena cava collapsibility index at baseline, PLR passive leg raising
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4643539&req=5

Fig1: Receiver operating characteristic curves for discriminating between volume expansion responders and nonresponders. ∆CO change in CO between baseline and after PLR, VCmax maximum inferior vena cava diameter at baseline, cIVC inferior vena cava collapsibility index at baseline, PLR passive leg raising
Mentions: The only significant correlation was between changes in CO during PLR challenge and changes in CO after volume expansion (r = 0.69, p = 0.0001). None of the other variables were correlated with CO changes after volume expansion (Table 4). The highest AUC values were found for ΔCO (0.78 ± 0.06; 95 % confidence interval (CI) [0.66-0.88], cIVC at baseline (0.62 ± 0.07; 95 %CI 0.49-0.74) and IVCmax at baseline (0.62 ± 0.07; 95 %CI 0.49-0.75) (Table 4, Fig. 1).Table 4

Bottom Line: There were no significant differences between responders and nonresponders at baseline, except for a higher aortic VTI in nonresponders (16 cm vs. 19 cm, p = 0.03).Prediction of fluid-responsiveness using cIVC and IVCmax was low (area under the curve for cIVC at baseline 0.62 ± 0.07; 95 %, CI 0.49-0.74 and for IVCmax at baseline 0.62 ± 0.07; 95 % CI 0.49-0.75).In SBP with suspected hypovolemia, vena cava size and respiratory variability do not predict fluid responsiveness.

View Article: PubMed Central - PubMed

Affiliation: Intensive Care Unit, Department of Nephrology, Amiens University Medical Center, 80054, Cedex 1, Amiens, France. airapetian.norair@chu-amiens.fr.

ABSTRACT

Introduction: We have almost no information concerning the value of inferior vena cava (IVC) respiratory variations in spontaneously breathing ICU patients (SBP) to predict fluid responsiveness.

Methods: SBP with clinical fluid need were included prospectively in the study. Echocardiography and Doppler ultrasound were used to record the aortic velocity-time integral (VTI), stroke volume (SV), cardiac output (CO) and IVC collapsibility index (cIVC) ((maximum diameter (IVCmax)- minimum diameter (IVCmin))/ IVCmax) at baseline, after a passive leg-raising maneuver (PLR) and after 500 ml of saline infusion.

Results: Fifty-nine patients (30 males and 29 females; 57 ± 18 years-old) were included in the study. Of these, 29 (49 %) were considered to be responders (≥10 % increase in CO after fluid infusion). There were no significant differences between responders and nonresponders at baseline, except for a higher aortic VTI in nonresponders (16 cm vs. 19 cm, p = 0.03). Responders had a lower baseline IVCmin than nonresponders (11 ± 5 mm vs. 14 ± 5 mm, p = 0.04) and more marked IVC variations (cIVC: 35 ± 16 vs. 27 ± 10 %, p = 0.04). Prediction of fluid-responsiveness using cIVC and IVCmax was low (area under the curve for cIVC at baseline 0.62 ± 0.07; 95 %, CI 0.49-0.74 and for IVCmax at baseline 0.62 ± 0.07; 95 % CI 0.49-0.75). In contrast, IVC respiratory variations >42 % in SBP demonstrated a high specificity (97 %) and a positive predictive value (90 %) to predict an increase in CO after fluid infusion.

Conclusions: In SBP with suspected hypovolemia, vena cava size and respiratory variability do not predict fluid responsiveness. In contrast, a cIVC >42 % may predict an increase in CO after fluid infusion.

No MeSH data available.


Related in: MedlinePlus