Inferior Vena Cava Variation Compared to Pulse Contour Analysis as Predictors of Fluid Responsiveness: A Prospective Cohort Study

Machare-Delgado, Enrique; DeCaro, Matthew; Marik, Paul E.

doi:10.1177/0885066610384192

Cited by 94 publications

(54 citation statements)

References 63 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Following this study there was a revolution in ultrasound technology which facilitated a less invasive approach, and in 2016 most clinicians prefer transthoracic echocardiography rather than the transesophageal approach to assess the IVC. Multiple studies analyzed the IVC in ICU patients under controlled mechanical ventilation [41–44]. Together these studies demonstrated that, like static measures of central venous pressure, the absolute size of the IVC was not able to accurately predict the effect of fluid infusion on cardiac output.…”

Section: Mechanical Ventilation Induced Variations In Vena-caval Diammentioning

confidence: 99%

Echocardiography as a guide for fluid management

et al. 2016

View full text Add to dashboard Cite

BackgroundIn critically ill patients at risk for organ failure, the administration of intravenous fluids has equal chances of resulting in benefit or harm. While the intent of intravenous fluid is to increase cardiac output and oxygen delivery, unwelcome results in those patients who do not increase their cardiac output are tissue edema, hypoxemia, and excess mortality. Here we briefly review bedside methods to assess fluid responsiveness, focusing upon the strengths and pitfalls of echocardiography in spontaneously breathing mechanically ventilated patients as a means to guide fluid management. We also provide new data to help clinicians anticipate bedside echocardiography findings in vasopressor-dependent, volume-resuscitated patients.ObjectiveTo review bedside ultrasound as a method to judge whether additional intravenous fluid will increase cardiac output. Special emphasis is placed on the respiratory effort of the patient.ConclusionsPoint-of-care echocardiography has the unique ability to screen for unexpected structural findings while providing a quantifiable probability of a patient’s cardiovascular response to fluids. Measuring changes in stroke volume in response to either passive leg raising or changes in thoracic pressure during controlled mechanical ventilation offer good performance characteristics but may be limited by operator skill, arrhythmia, and open lung ventilation strategies. Measuring changes in vena caval diameter induced by controlled mechanical ventilation demands less training of the operator and performs well during arrythmia. In modern delivery of critical care, however, most patients are nursed awake, even during mechanical ventilation. In patients making respiratory efforts we suggest that ventilator settings must be standardized before assessing this promising technology as a guide for fluid management.

show abstract

Section: Mechanical Ventilation Induced Variations In Vena-caval Diammentioning

confidence: 99%

Echocardiography as a guide for fluid management

et al. 2016

View full text Add to dashboard Cite

show abstract

“…Moreover, if cardiopulmonary function cannot compensate for the increase in preload, fluid loading may compromise microvascular perfusion and oxygen delivery and cause or aggravate peripheral and pulmonary edema [3,4]. Therefore, inappropriate fluid expansion can increase morbidity and mortality [5-7], making it important to accurately assess fluid responsiveness in critically ill patients [8,9]. …”

Section: Introductionmentioning

confidence: 99%

A 10-second fluid challenge guided by transthoracic echocardiography can predict fluid responsiveness

Zhou

et al. 2014

Crit Care

View full text Add to dashboard Cite

IntroductionThe accurate assessment of intravascular volume status for the therapy of severe hypovolemia and shock is difficult and critical to critically ill patients. Non-invasive evaluation of fluid responsiveness by the rapid infusion of a very limited amount of volume is an important clinical goal. This study aimed to test whether echocardiographic parameters could predict fluid responsiveness in critically ill patients following a low-volume (50-ml crystalloid solution) infusion over 10 seconds.MethodsWe prospectively studied 55 mechanically ventilated patients. Echocardiography was performed during a 50-ml infusion of crystalloid solution over 10 seconds and a further 450 ml over 15 minutes. Cardiac output (CO), stroke volume (SV), aortic velocity time index (VTI), and left ventricular ejection fraction (LVEF) were recorded. Patients were classified as responders (Rs) if CO increased by at least 15% following the 500-ml volume expansion or were classified as non-responders (NRs) if CO increased by less than 15%. Area under the receiver operating characteristic curves (AUC) compared CO variations after 50 ml over 10 seconds (∆CO50) and 500 ml over 15 minutes (∆CO500) and the variation of VTI after infusion of 50 ml of fluid over 10 seconds (∆VTI50).ResultsIn total, 50 patients were enrolled, and 27 (54%) of them were Rs. General characteristics, LVEF, heart rate, and central venous pressure were similar between Rs and NRs. In the Rs group, the AUC for ∆CO50 was 0.95 ± 0.03 (P <0.01; best cutoff value, 6%; sensitivity, 93%; specificity, 91%). Moreover, ∆CO50 and ∆CO500 were strongly correlated (r = 0.87; P <0.01). The AUC for ∆VTI50 was 0.91 ± 0.04 (P <0.01; best cutoff value, 9%; sensitivity, 74%; specificity, 95%). ∆VTI50 and ∆CO500 were positively correlated (r = 0.72; P <0.01).ConclusionIn critically ill patients, the variation of CO and VTI after the administration of 50-ml crystalloid solution over 10 seconds (∆CO50 and ∆VTI50) can accurately predict fluid responsiveness.Trial registrationCurrent Controlled Trials ISRCTN10524328. Registered 12 December 2013.

show abstract

“…They found no association between this and the expected hemodynamic response, as measured by CO from transthoracic echocardiography. Feissel et al 77 assessed performance of IVC respiratory variation in a cohort of mechanically ventilated MICU patients; they found that an IVC distensibility index of 12% not only identified volume responders (defined as an increase in CO >15% with 8 mL/kg of colloid) with a positive predictive value and negative predictive value both >92%, but it also correlated highly with CO. Machare-Delgado et al 34 demonstrated that a >12% respiratory variation in IVC was able to identify volume responsiveness (defined as a >10% increase in stroke volume index, the stroke volume divided by body surface area) with a sensitivity of 100% and specificity of 53%. (The investigators did not use airway pressure to gauge the appropriate measurement times for expiration and inspiration, potentially accounting for the low specificity.)…”

Section: Respiratory Variation Of Echocardiographic Parametersmentioning

confidence: 99%

Applied Physiology at the Bedside to Drive Resuscitation Algorithms

Holder

Pinsky

2014

Journal of Cardiothoracic and Vascular Anesthesia

View full text Add to dashboard Cite

Hemodynamic instability is associated with significant morbidity and mortality. Goal-directed therapeutic algorithms have been used in various clinical settings to reverse or prevent organ damage and death that could occur with a low oxygen delivery state. Most current resuscitative algorithms use static physiologic measures to determine if a patient will respond to proven therapies. While static parameters are useful in identifying the potential for clinical instability, they cannot tell us how patients will respond to an intervention. Applied physiology, through the use of functional hemodynamic monitoring can predict the body's reaction to therapy because they are based on cardiovascular dynamics. A growing body of evidence supports the use of applied physiologic principles in goal directed therapeutic algorithms for appropriate and effective resuscitation/optimization. Over time, applied physiology should be incorporated into standardized protocol-driven care to improve outcomes in patients experiencing, or at risk for hemodynamic instability.

show abstract

Inferior Vena Cava Variation Compared to Pulse Contour Analysis as Predictors of Fluid Responsiveness: A Prospective Cohort Study

Cited by 94 publications

References 63 publications

Echocardiography as a guide for fluid management

Echocardiography as a guide for fluid management

A 10-second fluid challenge guided by transthoracic echocardiography can predict fluid responsiveness

Applied Physiology at the Bedside to Drive Resuscitation Algorithms

Contact Info

Product

Resources

About