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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

Inferior vena cava collapsibility index at baseline (expressed as a percentage) in responders and nonresponders. Individual values (open circles) and the mean ± SD per group (filled circles and solid lines). Se sensitivity, Sp specificity. * p <0.05 vs. nonresponders
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Fig2: Inferior vena cava collapsibility index at baseline (expressed as a percentage) in responders and nonresponders. Individual values (open circles) and the mean ± SD per group (filled circles and solid lines). Se sensitivity, Sp specificity. * p <0.05 vs. nonresponders

Mentions: In practical terms, a reduction in IVC diameter of 42 % or more in spontaneously breathing patients distinguished between responders and nonresponders with high specificity (97 %) and a positive predictive value (90 %) but low sensitivity (Fig. 2, Table 5). We found that IVCmax at baseline had little predictive value for fluid responsiveness (Table 5, Figs. 1 and 3). However, an increase in CO of 9.5 % or more during PLR distinguished responders from nonresponders with high specificity (87 %), a high positive predictive value (79 %), low sensitivity (52 %) and low negative predictive value (65 %) (Fig. 1).Fig. 2


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)

Inferior vena cava collapsibility index at baseline (expressed as a percentage) in responders and nonresponders. Individual values (open circles) and the mean ± SD per group (filled circles and solid lines). Se sensitivity, Sp specificity. * p <0.05 vs. nonresponders
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

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

Fig2: Inferior vena cava collapsibility index at baseline (expressed as a percentage) in responders and nonresponders. Individual values (open circles) and the mean ± SD per group (filled circles and solid lines). Se sensitivity, Sp specificity. * p <0.05 vs. nonresponders
Mentions: In practical terms, a reduction in IVC diameter of 42 % or more in spontaneously breathing patients distinguished between responders and nonresponders with high specificity (97 %) and a positive predictive value (90 %) but low sensitivity (Fig. 2, Table 5). We found that IVCmax at baseline had little predictive value for fluid responsiveness (Table 5, Figs. 1 and 3). However, an increase in CO of 9.5 % or more during PLR distinguished responders from nonresponders with high specificity (87 %), a high positive predictive value (79 %), low sensitivity (52 %) and low negative predictive value (65 %) (Fig. 1).Fig. 2

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