Assessment of fluid responsiveness by inferior vena cava diameter variation in post‐pneumonectomy patients

Abstract

Aim First, the inferior vena cava dilatation index (DIVC) was measured by ultrasound, and then the reliability of DIVC as an indicator to predict volume responsiveness in patients undergoing mechanical ventilation after pneumonectomy was evaluated. Methods Pulse indicator continuous cardiac output (Picco) as gold standard was performed to sedated mechanically ventilated post‐pneumonectomy patients in intensive care unit of Nanjing Thoracic Hospital from August 2014 to December 2016. Meanwhile, ultrasound measurement to inferior vena cava (IVC) diameter at the end inspiration ( D max ) and the end of expiration ( D min ) was performed. DIVC = ( D max − D min )/ D min . Above values were recorded at baseline and then after fluid resuscitation challenge (7 mL/kg hydroxyethyl starch). An increase in cardiac index of more than 15% was used as the standard for fluid responsiveness. Patients were divided into responsive group and non‐responsive group. A receiver operating characteristic (ROC) curve was then used to determine the sensitivity and specificity of DIVC in predicting fluid responsiveness after pneumonectomy. Results Eighteen patients were enrolled. 10 patients were divided into responsive group and eight in non‐responsive group. DIVC in responsive group was significantly higher than in non‐responsive group ( P < 0.01). By setting DIVC ≥ 15% as a measure of fluid responsiveness, sensitivity was 81.8% and specificity was 85.7%. Conclusion DIVC is a reliable indicator of capacity responsiveness in mechanically ventilated post‐pneumonectomy patients.

Diagnostic Accuracy of Ultrasonographic Respiratory Variation in the Inferior Vena Cava, Subclavian Vein, Internal Jugular Vein, and Femoral Vein Diameter to Predict Fluid Responsiveness: A Systematic Review and Meta-Analysis

“…After the full-text review, 62 articles were excluded due to insufficient data ( n = 36), lack of 2-by-2 data ( n = 25), and not being original ( n = 1). Finally, 30 studies [ 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 ] comprising 1719 patients were included in this review ( Figure 1 ); detailed information about the eligible studies is shown in Table 1 . In cases of the IJV [ 29 , 36 , 42 ], FV (was not detected), and SCV [ 41 ], we were not able to conduct the meta-analysis due to an insufficient number of studies.…”

“…All 30 eligible studies were summarized in Table 1 . Twenty-eight studies [ 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 ] comprised the measurement of the IVC. Only three studies [ 29 , 36 , 42 ] comprised that of the IJV and one study [ 41 ] comprised that of the SCV.…”

“…In our searches, there was no relevant study that comprised measurements of the FV. Twenty-three studies used the M-mode of ultrasonography [ 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 37 , 39 , 41 , 42 , 43 , 45 , 47 , 50 ]. Seventeen studies used echocardiography as a reference standard [ 21 , 22 , 24 , 25 , 26 , 27 , 30 , 31 , 32 , 38 , 39 , 40 , 45 , 47 , 48 , 49 ].…”

“…Four studies used invasive devices that extracted the waveform in arteries [ 29 , 33 , 34 , 42 ]. Ten studies comprised patients with sepsis [ 21 , 22 , 26 , 27 , 29 , 33 , 36 , 37 , 39 , 48 ] and 18 comprised those on mechanical ventilation [ 21 , 22 , 23 , 24 , 27 , 29 , 31 , 32 , 33 , 34 , 37 , 38 , 41 , 42 , 43 , 45 , 46 , 47 ]. In the eligible studies, the ΔIVC was measured in three ways: first, the IVC collapsibility [ 25 , 26 , 28 , 30 , 35 , 36 , 39 , 40 , 44 , 48 , 49 , 50 ] denotes (maximal IVC diameter—minimal IVC diameter) / IVC diameter (maximum); second, the IVC distensibility [ 21 , 23 , 24 , 27 ,…”

“…The threshold of index test (ΔIVC) ranged from 11.1 to 49%. The pooled sensitivity of ΔIVC in 28 eligible studies [ 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 ] was 0.75 (95% CI, 0.68–0.80, I2 = 73.8%) and the pooled specificity was 0.83 (95% CI, 0.79–0.86, I2 = 41.6%; Figure 2 ). The pooled positive likelihood ratio was 4.37 (95% CI, 3.58–5.33, I2 = 10.7%) and the pooled negative likelihood ratio was 0.30 (95% CI, 0.24–0.39, I2 = 75.8%).…”