Evaluation of volume responsiveness by pulse pressure variability and inferior vena cava dispensability index at different tidal volumes by mechanical ventilation

Abstract

This study investigated the effects of tidal volume (TV) on the diagnostic value of pulse pressure variation (PPV) and the inferior vena cava dispensability index (IVC-DI) for volume responsiveness during mechanical ventilation. In patients undergoing elective surgery with mechanical ventilation, different TVs of 6, 9, and 12 mL/kg were given for two min. The left ventricular outflow tract velocity-time integral (VTI) was measured by transthoracic echocardiography. The IVC-DI was measured at sub-xyphoid transabdominal long axis. The PPV was measured via the radial artery and served as baseline. Index measurements were repeated after fluid challenge. VTI increased by more than 15% after fluid challenge, which was considered as volume responsive. Seventy-nine patients were enrolled, 38 of whom were considered positive volume responsive. Baseline data between the response group and the non-response group were similar. Receiver operating characteristic curve confirmed PPV accuracy in diagnosing an increase in volume responsiveness with increased TV. When TV was 12 mL/kg, the PPV area under the curve (AUC) was 0.93 and the threshold value was 15.5%. IVC-DI had the highest diagnostic accuracy at a TV of 9 mL/kg and an AUC of 0.79, with a threshold value of 15.3%. When TV increased to 12 mL/kg, the IVC-DI value decreased. When the TV was 9 and 12 mL/kg, PPV showed improved performance in diagnosing volume responsiveness than did IVC-DI. PPV diagnostic accuracy in mechanically ventilated patients was higher than IVC-DI. PPV accuracy in predicting volume responsiveness was increased by increasing TV.

Diagnostic Accuracy of Ultrasonographic Respiratory Variation in the Inferior Vena Cava, Subclavian Vein, Internal Jugular Vein, and Femoral Vein Diameter to Predict Fluid Responsiveness: A Systematic Review and Meta-Analysis

“…After the full-text review, 62 articles were excluded due to insufficient data ( n = 36), lack of 2-by-2 data ( n = 25), and not being original ( n = 1). Finally, 30 studies [ 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 ] comprising 1719 patients were included in this review ( Figure 1 ); detailed information about the eligible studies is shown in Table 1 . In cases of the IJV [ 29 , 36 , 42 ], FV (was not detected), and SCV [ 41 ], we were not able to conduct the meta-analysis due to an insufficient number of studies.…”

“…Two studies [ 36 , 42 ] reported on both the IVC and IJV. He et al [ 45 ] reported on three subsets according to tidal volume (TV) (6 mL/kg, 9 mL/kg, 12 mL/kg) and the subset of 9 mL/kg TV showed the highest AUROC. Thus, we extracted the subset of 9 mL/kg TV.…”

“…All 30 eligible studies were summarized in Table 1 . Twenty-eight studies [ 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 ] comprised the measurement of the IVC. Only three studies [ 29 , 36 , 42 ] comprised that of the IJV and one study [ 41 ] comprised that of the SCV.…”

How to monitor cardiovascular function in critical illness in resource-limited settings

“…In invasively ventilated patients receiving tidal volumes at least 8 ml/kg predicted body weight and positive end-expiratory pressure (PEEP) 5 cmH 2 O or less, the inferior vena cava distensibility index, defined as (maximum inferior vena cava − minimum inferior vena cava)/minimum inferior vena cava × 100 (%) [ 33 ], is an accurate predictor of fluid responsiveness, with overall an excellent sensitivity and specificity. However, in patients who receive ventilation with a tidal volume less than 8 ml/kg predicted body weight, or PEEP above 5 cmH 2 O, the inferior vena cava distensibility index is inaccurate for predicting fluid responsiveness [ 34 ]. Also in spontaneous breathing patients, the inferior vena cava collapsibility index, defined as (maximum inferior vena cava − minimum inferior vena cava)/maximum inferior vena cava × 100 (%), is an inaccurate predictor of fluid responsiveness.…”

“…Also in spontaneous breathing patients, the inferior vena cava collapsibility index, defined as (maximum inferior vena cava − minimum inferior vena cava)/maximum inferior vena cava × 100 (%), is an inaccurate predictor of fluid responsiveness. Intensivists should be cautious when using these under such conditions [ 34 ].…”