Prospective analysis of cardiac collapsibility of inferior vena cava using ultrasonography

Sonoo, Tomohiro; Nakamura, Kensuke; Ando, Takehiro; Sen, Kon; Maeda, Akinori; Kobayashi, Etsuko; Sakuma, Ichiro; Doi, Kent; Nakajima, Susumu; Yahagi, Naoki

doi:10.1016/j.jcrc.2015.04.124

Cited by 24 publications

(30 citation statements)

References 10 publications

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“…Eventually, for feasibility reasons, we did not assess intra-abdominal and central venous pressures, which would have been highly helpful to understand the underlying physiological mechanisms involved in the respiratory variations of the IVC. Last, although IVC diameter changes throughout the cardiac cycle [ 35 ], IVC measurements were not taken with electrocardiogram synchronization to detect tele–diastole as usually recommended. This uncertainty in the end-diastolic measurement of the expiratory diameter of the IVC possibly impairs the diagnostic accuracy of cIVC but improves clinical feasibility.…”

Section: Discussionmentioning

confidence: 99%

Respiratory changes of the inferior vena cava diameter predict fluid responsiveness in spontaneously breathing patients with cardiac arrhythmias

Bortolotti

Colling

Colas

et al. 2018

Ann. Intensive Care

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BackgroundWhether the respiratory changes of the inferior vena cava diameter during a deep standardized inspiration can reliably predict fluid responsiveness in spontaneously breathing patients with cardiac arrhythmia is unknown.MethodsThis prospective two-center study included nonventilated arrhythmic patients with infection-induced acute circulatory failure. Hemodynamic status was assessed at baseline and after a volume expansion of 500 mL 4% gelatin. The inferior vena cava diameters were measured with transthoracic echocardiography using the bi-dimensional mode on a subcostal long-axis view. Standardized respiratory cycles consisted of a deep inspiration with concomitant control of buccal pressures and passive exhalation. The collapsibility index of the inferior vena cava was calculated as [(expiratory–inspiratory)/expiratory] diameters.ResultsAmong the 55 patients included in the study, 29 (53%) were responders to volume expansion. The areas under the ROC curve for the collapsibility index and inspiratory diameter of the inferior vena cava were both of 0.93 [95% CI 0.86; 1]. A collapsibility index ≥ 39% predicted fluid responsiveness with a sensitivity of 93% and a specificity of 88%. An inspiratory diameter < 11 mm predicted fluid responsiveness with a sensitivity of 83% and a specificity of 88%. A correlation between the inspiratory effort and the inferior vena cava collapsibility was found in responders but was absent in nonresponder patients.ConclusionsIn spontaneously breathing patients with cardiac arrhythmias, the collapsibility index and inspiratory diameter of the inferior vena cava assessed during a deep inspiration may be noninvasive bedside tools to predict fluid responsiveness in acute circulatory failure related to infection. These results, obtained in a small and selected population, need to be confirmed in a larger-scale study before considering any clinical application.Electronic supplementary materialThe online version of this article (10.1186/s13613-018-0427-1) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

Respiratory changes of the inferior vena cava diameter predict fluid responsiveness in spontaneously breathing patients with cardiac arrhythmias

Bortolotti

Colling

Colas

et al. 2018

Ann. Intensive Care

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“…The values of these data were compared between the three postures in each patient. Additionally, the distribution of the measured values of IVCDmax in each posture was described in each patient, since IVCDmax might be a reliable indicator of intravascular volume status [12][13][14].…”

Section: Ultrasonographymentioning

confidence: 99%

Preanesthetic Ultrasonography Assessment of Inferior Vena Cava Diameter in the Supine Position, Left Lateral Tilt Position, and with the Left Uterine Displacement Maneuver in Full-Term Pregnant Women: A Randomized Cross-Over Design Study

Furuya

Hirose

Sato

et al. 2021

Preprint

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BackgroundWe used preanesthetic ultrasonography evaluation to study the effectiveness of left lateral tilt position (LLT) and the left uterine displacement maneuver (LUD) on increasing inferior vena cava diameter (IVCD) in healthy full-term pregnant women, using a randomized, single blinded, cross-over design study.MethodsTwenty-two parturients scheduled for elective cesarean section under spinal anesthesia were recruited. All patients were sequentially placed in the supine position (SPN), LLT and with LUD before induction of spinal anesthesia. Indices of IVCD, measured by subxiphoid ultrasonography, including maximum IVCD (IVCDmax), minimum IVCD (IVCDmin) and collapsibility index (CI), and hemodynamic parameters, such as heart rate and blood pressure, were recorded in each of the postures. Mean or median values of all measurements were compared among the postures.ResultsThe mean values of IVCDmax observed with both LLT and LUD were significantly larger than those in the SPN, respectively (SPN vs. LLT: P <0.05, SPN vs. LUD: P <0.01), although there were no significant differences between IVCDmax with LLT and LUD. There were no significant differences in IVCDmin, CI and hemodynamic parameters between any of the postures. IVCDmax was highest with LUD in 11 patients (55%), in the LLT position in seven patients (35%) and in the SPN in two patients (10%).ConclusionsLLT and LUD might be equally effective in enlarging the narrowed IVCD as compared to SPN. However, both LLT and LUD might not necessarily be appropriate treatment to relieve IVC compression in some cases.Trial registrationThis study was registered in the “UMIN Clinical Trials Registry” (ID no.: 000024344, date. 10th October 2016).

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“…American Society of Echocardiography, emphasize the importance of IVC respiratory variability in determining an estimation of central venous pressure. [3][4][5][6][7][8] Thus, we believe that a familiarity with the above pitfalls is essential, especially when IVC collapsibility as judged by sonography is inconsistent with the patient's overall clinical picture. In particular, the 2010 American Society of Echocardiography guidelines 3 specify that the IVC be measured at the level of the hepatic vein inlet, which unfortunately is exactly the location where it is vulnerable to the phenomena described above.…”

Section: Clinical Lettermentioning

confidence: 99%

“…Most research from the critical care and emergency medicine arenas, as well as current guidelines from the American Society of Echocardiography, emphasize the importance of IVC respiratory variability in determining an estimation of central venous pressure . Thus, we believe that a familiarity with the above pitfalls is essential, especially when IVC collapsibility as judged by sonography is inconsistent with the patient's overall clinical picture.…”

mentioning

confidence: 99%

Technical Pitfalls in Sonography of the Inferior Vena Cava: Beware the Diaphragm

et al. 2017

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Prospective analysis of cardiac collapsibility of inferior vena cava using ultrasonography

Cited by 24 publications

References 10 publications

Respiratory changes of the inferior vena cava diameter predict fluid responsiveness in spontaneously breathing patients with cardiac arrhythmias

Respiratory changes of the inferior vena cava diameter predict fluid responsiveness in spontaneously breathing patients with cardiac arrhythmias

Preanesthetic Ultrasonography Assessment of Inferior Vena Cava Diameter in the Supine Position, Left Lateral Tilt Position, and with the Left Uterine Displacement Maneuver in Full-Term Pregnant Women: A Randomized Cross-Over Design Study

Technical Pitfalls in Sonography of the Inferior Vena Cava: Beware the Diaphragm

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