Bedside sonographic measurement of the inferior vena cava caval index is a poor predictor of fluid responsiveness in emergency department patients

Abstract

Bedside sonographic measurement of IVC caval index does not predict FR in a heterogeneous ED patient population. Further research using this technique in targeted patient subsets and a variety of shock etiologies is needed.

Fluid responsiveness predicted by elevation of PEEP in patients with septic shock

“…23,24,[30][31][32] These dynamic methods are quite accurate in controlled situations but may have several limitations in clinical practice. 13,33 Most importantly, the use of low tidal volumes (< 8 ml/kg), arrhythmias and differing calculations of PPV, SPV, and SVV reduce the reliability of these measures. 13,14 Although PLR is useful in predicting fluid responsiveness also in patients with arrhythmias and spontaneous breathing activity, it requires real-time assessment of aortic blood flow, 15 which may not be available in the ICU.…”

Rebuttal From Dr Kory

“…Unfortunately, this "meta-analysis" contains too many limitations to be useful: 1) only a single study of IVC collapse in spontaneously breathing patients was used to calculate the odds ratio (the study by Muller et al (4) in which 40% of patients were in shock from clinically overt hypovolemic insults), 2) one "negative" study of IVC collapse by Brun et al (5) was excluded after being mischaracterized as not having studied spontaneously breathing patients, 3) another "negative" study by Corl et al (6) was excluded due to incomplete data for metaanalysis and 4) it was published prior to three more of the largest "negative" studies on IVC collapse (7-9). The more current summary from Table 1 in the article above (10) far better demonstrates it's actual poor predictability.…”

Descifrando la Vena Cava Inferior

“…Diagrama de Guyton. La intersección de las dos curvas define el punto de funcionamiento del sistema cardiovascular A pesar de lo que se pueda creer, esta caída inspiratoria del valor de la PVC no nos dice nada acerca del estado del volumen de un paciente (es decir, si el paciente es o no euvolémico) o de la respuesta al volumen (si el paciente va a aumentar su gasto cardíaco con la administración de líquidos) (1,6,7) . La razón es que la PVC depende de la intersección del retorno venoso y la función cardíaca, dos fenómenos fisiológicos cada uno con múltiples determinantes.…”