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Crit Care. 2015 Nov 13;19:400. doi: 10.1186/s13054-015-1100-9.

Does inferior vena cava respiratory variability predict fluid responsiveness in spontaneously breathing patients?

Author information

1
Intensive Care Unit, Department of Nephrology, Amiens University Medical Center, 80054, Cedex 1, Amiens, France. airapetian.norair@chu-amiens.fr.
2
Department of Anesthesiology and Intensive Care, Amiens University Medical Center, Amiens, France. airapetian.norair@chu-amiens.fr.
3
Intensive Care Unit, Department of Nephrology, Amiens University Medical Center, 80054, Cedex 1, Amiens, France. maizel.julien@chu-amiens.fr.
4
INSERM U-1088, Jules Verne University of Picardie, Amiens, France. maizel.julien@chu-amiens.fr.
5
Department of Anesthesiology and Intensive Care, Amiens University Medical Center, Amiens, France. alyamani.ola@chu-amiens.fr.
6
Department of Anesthesiology and Intensive Care, Amiens University Medical Center, Amiens, France. mahjoub.yazine@chu-amiens.fr.
7
INSERM U-1088, Jules Verne University of Picardie, Amiens, France. mahjoub.yazine@chu-amiens.fr.
8
Department of Anesthesiology and Intensive Care, Amiens University Medical Center, Amiens, France. lorne.emmanuel@chu-amiens.fr.
9
INSERM U-1088, Jules Verne University of Picardie, Amiens, France. lorne.emmanuel@chu-amiens.fr.
10
Department of Anesthesiology and Intensive Care, Amiens University Medical Center, Amiens, France. levrard.melanie@chu-amiens.fr.
11
Department of Anesthesiology and Intensive Care, Amiens University Medical Center, Amiens, France. ammenouche.nacim@chu-amiens.fr.
12
Department of Anesthesiology and Intensive Care, Amiens University Medical Center, Amiens, France. seydi.aziz@chu-amiens.fr.
13
Department of Anesthesiology and Intensive Care, Amiens University Medical Center, Amiens, France. tinturier.francois@chu-amiens.fr.
14
Department of Anesthesiology and Intensive Care, Amiens University Medical Center, Amiens, France. lobjoie.eric@chu-amiens.fr.
15
Department of Anesthesiology and Intensive Care, Amiens University Medical Center, Amiens, France. dupont.herve@chu-amiens.fr.
16
INSERM U-1088, Jules Verne University of Picardie, Amiens, France. dupont.herve@chu-amiens.fr.
17
Intensive Care Unit, Department of Nephrology, Amiens University Medical Center, 80054, Cedex 1, Amiens, France. slama.michel@chu-amiens.fr.
18
INSERM U-1088, Jules Verne University of Picardie, Amiens, France. slama.michel@chu-amiens.fr.

Abstract

INTRODUCTION:

We have almost no information concerning the value of inferior vena cava (IVC) respiratory variations in spontaneously breathing ICU patients (SBP) to predict fluid responsiveness.

METHODS:

SBP with clinical fluid need were included prospectively in the study. Echocardiography and Doppler ultrasound were used to record the aortic velocity-time integral (VTI), stroke volume (SV), cardiac output (CO) and IVC collapsibility index (cIVC) ((maximum diameter (IVCmax)- minimum diameter (IVCmin))/ IVCmax) at baseline, after a passive leg-raising maneuver (PLR) and after 500 ml of saline infusion.

RESULTS:

Fifty-nine patients (30 males and 29 females; 57 ± 18 years-old) were included in the study. Of these, 29 (49 %) were considered to be responders (≥10 % increase in CO after fluid infusion). There were no significant differences between responders and nonresponders at baseline, except for a higher aortic VTI in nonresponders (16 cm vs. 19 cm, p = 0.03). Responders had a lower baseline IVCmin than nonresponders (11 ± 5 mm vs. 14 ± 5 mm, p = 0.04) and more marked IVC variations (cIVC: 35 ± 16 vs. 27 ± 10 %, p = 0.04). Prediction of fluid-responsiveness using cIVC and IVCmax was low (area under the curve for cIVC at baseline 0.62 ± 0.07; 95 %, CI 0.49-0.74 and for IVCmax at baseline 0.62 ± 0.07; 95 % CI 0.49-0.75). In contrast, IVC respiratory variations >42 % in SBP demonstrated a high specificity (97 %) and a positive predictive value (90 %) to predict an increase in CO after fluid infusion.

CONCLUSIONS:

In SBP with suspected hypovolemia, vena cava size and respiratory variability do not predict fluid responsiveness. In contrast, a cIVC >42 % may predict an increase in CO after fluid infusion.

PMID:
26563768
PMCID:
PMC4643539
DOI:
10.1186/s13054-015-1100-9
[Indexed for MEDLINE]
Free PMC Article

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