Inferior vena cava evaluation in fluid therapy decision making in intensive care: practical implications

Abstract

The fluid resuscitation of patients with acute circulatory failure aims to increase systolic volume and consequently improve cardiac output for better tissue oxygenation. However, this effect does not always occur because approximately half of patients do not respond to fluids. The evaluation of fluid responsiveness before their administration may help to identify patients who would benefit from fluid resuscitation and avoid the risk of fluid overload in the others. The dynamic parameters of fluid responsiveness evaluation are promising predictive factors. Of these, the echocardiographic measurement of the respiratory variation in the inferior vena cava diameter is easy to apply and has been used in the hemodynamic evaluation of intensive care unit patients. However, the applicability of this technique has many limitations, and the present studies are heterogeneous and inconsistent across specific groups of patients. We review the use of the inferior vena cava diameter respiratory variation, measured via transthoracic echocardiography, to decide whether to administer fluids to patients with acute circulatory failure in the intensive care unit. We explore the benefits and limitations of this technique, its current use, and the existing evidence.

Can blood loss be assessed by echocardiography? An experimental study on a controlled hemorrhagic shock model in piglets

“…∆IVC was not correlated to volume of hemorrhage in this model. The use of ΔIVC as a predictor of fluid filling response is increasingly challenged in recent literature, 30–32 moreover in spontaneously breathing patients 10,33 …”

Accuracy of echocardiography and ultrasound protocol to identify shock etiology in emergency department

“… Signs of cardiac tamponade Signs of pulmonary embolism Valves for infective endocarditis, stenosis or regurgitation Aorta to detect aortic dissection or rupture aneurysm. IVC size, collapsibility and distensibility index were calculated [ 10 , 11 ] In case of unvisualized IVC, internal jugular vein (IJV) was used instead. Focused Assessment with Sonography for trauma (FAST) exam.…”

The POCUS Consult: How Point of Care Ultrasound Helps Guide Medical Decision Making

“… 59 Variation in transpulmonary pressure during respiration is transmitted to the right heart, which impacts venous return and IVC diameter. 60 In spontaneous ventilation, negative transpulmonary pressure at the beginning of inspiration increases venous return from the vena cavae, resulting in IVC collapse as a function of its compliance. 60 Patients with a reduced right-heart pressure and high IVC compliance (eg, from hypovolemia) will demonstrate significant collapse of their IVC during inspiration.…”

“… 60 In spontaneous ventilation, negative transpulmonary pressure at the beginning of inspiration increases venous return from the vena cavae, resulting in IVC collapse as a function of its compliance. 60 Patients with a reduced right-heart pressure and high IVC compliance (eg, from hypovolemia) will demonstrate significant collapse of their IVC during inspiration. Conversely, patients with elevated right-heart pressure will not have significant collapse of their IVC during inspiration.…”

“…Conversely, patients with elevated right-heart pressure will not have significant collapse of their IVC during inspiration. 60 The opposite response occurs during controlled, positive-pressure ventilation (PPV), where the IVC distends during inspiration. 61 , 62 The change in IVC diameter during PPV is directly proportional to its compliance.…”