Inferior vena cava collapsibility to guide fluid removal in slow continuous ultrafiltration: a pilot study

Guiotto, Giovanna; Masarone, Mario; Paladino, Fiorella; Ruggiero, Enrico; Scott, Sean; Verde, S; Schiraldi, Fernando

doi:10.1007/s00134-009-1745-4

Cited by 64 publications

(59 citation statements)

References 18 publications

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“…It remains to be established whether a different approach, IVCCI serial determination -based, would have prevented or reduced the occurrence of ARD diuretic-related by more careful tailoring of diuretic therapy within the first 48 hours. On the basis of our results, it is also reasonable to speculate that renal impairment in CHF patients may be frequently related to subclinical condition of subtle intravascular volume depletion, whose relatively high (>40%) IVC collapsibility is a reliable marker (31). Actually in our study (Fig.…”

Section: Discussionsupporting

confidence: 68%

“…Meanwhile, glomerular filtration is simultaneously damaged by a peculiar type of unfavorable vasomotor kidney reaction (14,15) consisting in intense vasoconstriction of the afferent arteriolar bed, as elicited by macula densa chemoceptor apparatus highly sensitive to increased delivery of sodium to tubules due to diuretic administration. According to several authors (31,38) this "vasomotor nephropathy" could be minimized using slow mechanical fluid removal by ultrafiltration. In this manner, we could avoid engaging renal excretory pathways and their inherent tubulo-glomerular feedback, whose role in nephrotoxic effect of diuretics in syndromes with reduced effective circulating volume (CHF, cirrhosis of the liver) has been focused in other studies (38,39).…”

Section: Diuretic-related Wrf: Interpretative Theoriesmentioning

confidence: 99%

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Ultrasound evaluation of the inferior vena cava collapsibility index in congestive heart failure patients treated with intravenous diuretics: new insights about its relationship with renal function: An observational study

Vecchis¹,

Ariano²,

Fusco³

et al. 2012

Anadolu Kardiyol Derg

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Ultrasound evaluation of the inferior vena cava collapsibility index in congestive heart failure patients treated with intravenous diuretics: new insights about its relationship with renal function: An observational study ABSTRACTObjective: In chronic heart failure (CHF), collapsibility index of the inferior vena cava (IVCCI) is used for noninvasive ultrasonographic appraisal of central venous pressure, but it also may be related both to estimated glomerular filtration rate (eGFR) and renal outcome. Methods: On the basis of retrospective observational cohort study, we analyzed 49 patients with right or biventricular CHF in III NYHA class, who had undergone intravenous intensive treatment with furosemide. Aggravated renal dysfunction (ARD) was defined by serum creatinine (Cr) increase of ≥0.3 mg/dL from baseline. IVCCI was categorized in three layers (IVCCI ≤15%, IVCCI 16-40% and IVCCI >40%). The predictors of ARD were searched for as well as any relation between basal IVCCI and both eGFR at admission and occurrence of ARD. Results: Overall, 15 cases and 34 controls were compared. Multivariate predictors of ARD were a lower basal eGFR (HR: 0.82 CI: 0.72-0.94 p=0.0045) and intravenous furosemide daily mean dose >80 mg (HR: 48.62 CI: 1.62-3841.5 p=0.0430). A very significant positive correlation was found between IVCCI at admission ≤ 15% and basal eGFR (r=0.96 p<0.0001), while a negative correlation with eGFR was detected in the IVCCI highest (>40%) range (r=-0.696 p=0.0013). Furthermore, the category with basal IVCCI >40% showed a higher rate of ARD compared to that with basal IVCCI 16-40% (p<0.05). Conclusion:On the basis of the demonstrated u-shaped relationship between IVCCI and eGFR both the stratum with the highest (>40%) and the one with the lowest (≤15%) basal IVCCI may be associated with increased risk of ARD. (Anadolu Kardiyol Derg 2012; 12: 391-400) Key words: Heart failure, ultrasound monitoring, inferior vena cava, diuretics, acute kidney injury, regression analysis

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Section: Discussionsupporting

confidence: 68%

Section: Diuretic-related Wrf: Interpretative Theoriesmentioning

confidence: 99%

Ultrasound evaluation of the inferior vena cava collapsibility index in congestive heart failure patients treated with intravenous diuretics: new insights about its relationship with renal function: An observational study

Vecchis¹,

Ariano²,

Fusco³

et al. 2012

Anadolu Kardiyol Derg

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“…Barbier et al and M Feissel et al demonstrated clearly that respiratory variation of the IVC reliably predicts fluid responsiveness [20,21]. Conversely, in acutely decompensated heart failure patients, the rate of fluid withdrawal during haemodialysis can be guided by intermittent evaluation of the respiratory induced alterations of the IVC diameters [22]. In this particular study, hypotension was observed in those patients with an IVC variation of > 30%.…”

Section: Mechanical Ventilator Induced Intra-thoracic Pressure Changementioning

confidence: 62%

Assessment of loading conditions with cardiac ultrasound. A comprehensive review

Poelaert¹

2015

Anaesthesiol Intensive Ther

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Optimization of the preloading conditions and concomitant determination of endpoints of fluid administration are the most frequent therapeutic actions in critically ill patients. Besides a clinical appraisal, reproducible data should be acquired at the bedside to estimate the adequacy of fluid resuscitation. The dynamic assessment and determination of fluid responsiveness plays a major role in this respect. Right-sided cardiac variables, such as inferior and superior caval vein diameter variation during mechanical ventilation, are easily obtained with cardiac ultrasound. Moreover, left sided variables, including aortic flow variation, with intermittent swings of intrathoracic pressure during mechanical ventilation, may be achieved non-invasively with Doppler-echocardiography. Both in terms of resuscitation, as well as correct interpretation of various two-dimensional and Doppler variables, it is essential to acquire a clear understanding of the filling status of a patient. Doppler-echocardiography plays herein a pivotal role.

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“…Also, the IVC-CI has been used to follow acute volume changes. Patients undergoing ultrafiltration with a total ultrafiltrate production of 5,780 mL, had a significantly increased IVC-CI (p \ 0.001), while there was no change in mean arterial pressures, heart rate, or the IVC diameter [35].…”

Section: Ultrasonographymentioning

confidence: 99%

Fluid-Volume Assessment in the Investigation of Acute Heart Failure

Tuy

Than

2013

Curr Emerg Hosp Med Rep

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Heart failure is a syndrome whereby cardiac function is incapable of providing for the body's circulatory demands, resulting in hemodynamic and volumetric aberrations. Acute heart failure (AHF) is the condition where signs and symptoms of heart failure are present that require urgent intervention. In AHF impaired cardiac function progresses to hemodynamic congestion and eventually develops into a fluid overloaded state. These patients will typically present acutely for medical assistance, with signs and symptoms of fluid overload (dyspnea, paroxysmal nocturnal dyspnea, orthopnea, edema, etc.) and/or hypoperfusion (malaise, altered mental status, decreased urine output). In patients with AHF, volume assessment is a crucial step in the initial diagnosis.

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Inferior vena cava collapsibility to guide fluid removal in slow continuous ultrafiltration: a pilot study

Abstract: IVC ultrasound is a rapid, simple, and non-invasive means for bedside monitoring of intravascular volume during SCUF and may guide fluid removal velocity.

Cited by 64 publications

References 18 publications

Ultrasound evaluation of the inferior vena cava collapsibility index in congestive heart failure patients treated with intravenous diuretics: new insights about its relationship with renal function: An observational study

Ultrasound evaluation of the inferior vena cava collapsibility index in congestive heart failure patients treated with intravenous diuretics: new insights about its relationship with renal function: An observational study

Assessment of loading conditions with cardiac ultrasound. A comprehensive review

Fluid-Volume Assessment in the Investigation of Acute Heart Failure

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