Comparison of Echocardiographic Indices Used to Predict Fluid Responsiveness in Ventilated Patients

Abstract

∆VmaxAo had the best sensitivity and ∆SVC the best specificity in predicting fluid responsiveness. ∆SVC had a greater diagnostic accuracy than ∆IVC and ∆PP, but its measurement requires transesophageal echocardiography.

Executive summary on the use of ultrasound in the critically ill: consensus report from the 3rd Course on Acute Care Ultrasound (CACU)

“…Although the function of the repaired valvular apparatus, the presence of paravalvular leaks, an systolic motion of the anterior mitral leaflet may all be examined, the effects of anaesthetic/sedatives, and the altered preload and afterload conditions must be taken into account. A large observational and prospective study performed in patients with shock has reported that the SVC collapsibility index has the best specificity, whereas respiratory variations of aortic blood flow possesses the best sensitivity [24].…”

“…However a recent study reported limited accuracy [24]. Respiratory variations of aortic blood flow recorded using a pulsed Doppler also reflect fluid-responsiveness [30].…”

“…Finally, intra-abdominal hypertension might invalidate inferior vena cava variability measurements. The accuracy of IVC and SVC variations to assess fluid-responsiveness were recently discussed in a large prospective study in which it was demonstrated that IVC is a poor predictor and the cut-off values are different than those previously published [24].…”

Echocardiography is a feasible tool for assessing volume responsiveness

“…Several small studies have demonstrated the utility of echocardiographic measures that exploit heart-lung interactions to predict fluid responsiveness in selected patients. Vignon and colleagues recently compared multiple echocardiographic indices to predict fluid responsiveness in ventilated patients (1). Their study is commendable for its large size, and its inclusion of several different categories of acute circulatory failure, including sepsis, hypovolemia, and cardiogenic shock.…”

Monitorage hémodynamique en 2017 : place de l’échocardiographie transœsophagienne

“…Chez les patients hémodynamiquement instables, l'évaluation de la volémie est un enjeu majeur et l'échocardiographie permet de guider le remplissage vasculaire. L'étude HEMOPRED a comparé prospectivement différents indices prédictifs de l'efficacité du remplissage sur le débit cardiaque chez des patients en insuffisance circulatoire, quel que soit le méca-nisme de celle-ci [7]. Pour identifier les patients répondeurs au remplissage, l'indice de collapsibilité de la veine cave supérieure (VCS), pouvant être obtenu uniquement par ETO, avait une meilleure spécificité que tous les autres indices testés (variation de la pression pulsée, variation de la vélocité maximale de l'ITV sous-aortique, indice de distensibilité de la veine cave inférieure), recueillis par ETT et via une pression artérielle sanglante.…”