Background
The collapsibility index of inferior vena cava (cIVC) is widely used to decide fluid infusion in spontaneously breathing intensive care unit patients. The authors hypothesized that high inspiratory efforts may induce false-positive high cIVC values. This study aims at determining a value of diaphragmatic motion recorded by echography that could predict a high cIVC (more than or equal to 40%) in healthy volunteers.
Methods
The cIVC and diaphragmatic motions were recorded for three levels of inspiratory efforts. Right and left diaphragmatic motions were defined as the maximal diaphragmatic excursions. Receiver operating characteristic curves evaluated the performance of right diaphragmatic motion to predict a cIVC more than or equal to 40% defining the best cutoff value.
Results
Among 52 included volunteers, interobserver reproducibility showed a generalized concordance correlation coefficient (ρc) above 0.9 for all echographic parameters. Right diaphragmatic motion correlated with cIVC (r = 0.64, P < 0.0001). Univariate analyses did not show association between cIVC and age, sex, weight, height, or body mass index. The area under the receiver operating characteristic curves for cIVC more than or equal to 40% was 0.87 (95% CI, 0.81 to 0.93). The best diaphragmatic motion cutoff was 28 mm (Youden Index, 0.65) with sensitivity of 89% and specificity of 77%. The gray zone area was 25 to 43 mm.
Conclusions
Inferior vena cava collapsibility is affected by diaphragmatic motion. During low inspiratory effort, diaphragmatic motion was less than 25 mm and predicted a cIVC less than 40%. During maximal inspiratory effort, diaphragmatic motion was more than 43 mm and predicted a cIVC more than 40%. When diaphragmatic motion ranged from 25 to 43 mm, no conclusion on cIVC value could be done.
Introduction: The high demand for critical care beds and the need for mechanical ventilation generated by the pandemia of COVID-19 led the Ministry of Health of Chile to authorize both the conversion of beds and the use of anesthesia machines to mechanically ventilate COVID-19 patients. At Clínica Alemana de Santiago (CAS), these converted units were managed by non-intensivist anesthesiologists with technical support from the Intensive Care Unit (ICU). The objective of this study was to compare the survival rate of patients managed at converted and traditional ICU units. The secondary objective was to analyze the factors that may affect morbidity and mortality of these patients. Method: This prospective observational study included mechanically ventilated COVID-19 patients in both traditional and converted units. Patients were followed for 90 days starting at intubation day. Survival rate was determined at 30 and 90 days. A survival analysis was then performed. Results: 41 and 42 patients were admitted to CAS trough converted and traditional ICU units, respectively, between May 24 and June 30, 2020. There was not significant difference in survival rate between converted and traditional ICU units. Age (HR 1.1 per year) and SOFA (HR 1.4 per point) were associated with survival. Conclusions: At CAS, the survival of COVID-19 patients who required mechanical ventilation in converted units was not different as in those patients treated in traditional ICU units. Both age and SOFA were variables that can inform about prognosis of these patients.
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