Diagnostic accuracy of inferior vena caval respiratory variation in detecting fluid unresponsiveness

Das, Saurabh; Choupoo, Nang Sujali; Pradhan, Debasis; Saikia, Priyam; Monnet, Xavier

doi:10.1097/eja.0000000000000841

Cited by 24 publications

(25 citation statements)

References 30 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Then it is not surprising that a low Vt, inducing lower changes in intrathoracic and transmural pressures, is responsible for a lower diagnostic ability compared to Vt ≥ 8 mL/kg. Nevertheless, it is important to emphasize that the reliability of IVCDV for detecting preload responsiveness has been found to be poor or moderate by many studies and meta-analyses, even in studies including patients with Vt ≥ 8 mL/kg [21,22]. Along with these studies, the present one shows that IVCDV is likely the dynamic index of fluid responsiveness with the poorest diagnostic value.…”

Section: Discussionsupporting

confidence: 54%

Do changes in pulse pressure variation and inferior vena cava distensibility during passive leg raising and tidal volume challenge detect preload responsiveness in case of low tidal volume ventilation?

et al. 2021

Self Cite

View full text Add to dashboard Cite

Background In patients ventilated with tidal volume (Vt) < 8 mL/kg, pulse pressure variation (PPV) and, likely, the variation of distensibility of the inferior vena cava diameter (IVCDV) are unable to detect preload responsiveness. In this condition, passive leg raising (PLR) could be used, but it requires a measurement of cardiac output. The tidal volume (Vt) challenge (PPV changes induced by a 1-min increase in Vt from 6 to 8 mL/kg) is another alternative, but it requires an arterial line. We tested whether, in case of Vt = 6 mL/kg, the effects of PLR could be assessed through changes in PPV (ΔPPVPLR) or in IVCDV (ΔIVCDVPLR) rather than changes in cardiac output, and whether the effects of the Vt challenge could be assessed by changes in IVCDV (ΔIVCDVVt) rather than changes in PPV (ΔPPVVt). Methods In 30 critically ill patients without spontaneous breathing and cardiac arrhythmias, ventilated with Vt = 6 mL/kg, we measured cardiac index (CI) (PiCCO2), IVCDV and PPV before/during a PLR test and before/during a Vt challenge. A PLR-induced increase in CI ≥ 10% defined preload responsiveness. Results At baseline, IVCDV was not different between preload responders (n = 15) and non-responders. Compared to non-responders, PPV and IVCDV decreased more during PLR (by − 38 ± 16% and − 26 ± 28%, respectively) and increased more during the Vt challenge (by 64 ± 42% and 91 ± 72%, respectively) in responders. ∆PPVPLR, expressed either as absolute or as percent relative changes, detected preload responsiveness (area under the receiver operating curve, AUROC: 0.98 ± 0.02 for both). ∆IVCDVPLR detected preload responsiveness only when expressed in absolute changes (AUROC: 0.76 ± 0.10), not in relative changes. ∆PPVVt, expressed as absolute or percent relative changes, detected preload responsiveness (AUROC: 0.98 ± 0.02 and 0.94 ± 0.04, respectively). This was also the case for ∆IVCDVVt, but the diagnostic threshold (1 point or 4%) was below the least significant change of IVCDV (9[3–18]%). Conclusions During mechanical ventilation with Vt = 6 mL/kg, the effects of PLR can be assessed by changes in PPV. If IVCDV is used, it should be expressed in percent and not absolute changes. The effects of the Vt challenge can be assessed on PPV, but not on IVCDV, since the diagnostic threshold is too small compared to the reproducibility of this variable. Trial registration: Agence Nationale de Sécurité du Médicament et des Produits de santé: ID-RCB: 2016-A00893-48.

show abstract

Section: Discussionsupporting

confidence: 54%

Do changes in pulse pressure variation and inferior vena cava distensibility during passive leg raising and tidal volume challenge detect preload responsiveness in case of low tidal volume ventilation?

et al. 2021

Self Cite

View full text Add to dashboard Cite

show abstract

“…In patients undergoing mechanical ventilation, the pooled sensitivity and specificity were 0.79 (95% CI, 0.67 to 0.86) and 0.70 (95% CI, 0.63 to 0.76), respectively. 23 However, in a study performed in septic pediatric patients, the ability of the CVCCI to discriminate between responders and nonresponders was poor, with an area under the ROC curve of 0.38 (95% CI, 0.23 to 0.55). 24 The differences with our study could be related to the different species and ages studied, as well as the underlying illnesses.…”

Section: Discussionmentioning

confidence: 96%

“…In a recent meta‐analysis evaluating the CVCCI capability to predict fluid responsiveness in spontaneously breathing human patients, CVCCI showed moderate accuracy with a pooled sensitivity of 0.80 (95% CI, 0.68 to 0.89) and a pooled specificity of 0.79 (95% CI, 0.60 to 0.90). In patients undergoing mechanical ventilation, the pooled sensitivity and specificity were 0.79 (95% CI, 0.67 to 0.86) and 0.70 (95% CI, 0.63 to 0.76), respectively 23 . However, in a study performed in septic pediatric patients, the ability of the CVCCI to discriminate between responders and nonresponders was poor, with an area under the ROC curve of 0.38 (95% CI, 0.23 to 0.55) 24 .…”

Section: Discussionmentioning

confidence: 99%

Caudal vena cava collapsibility index as a tool to predict fluid responsiveness in dogs

Donati¹,

Guevara²,

Ardiles

et al. 2020

J Vet Emergen Crit Care

View full text Add to dashboard Cite

show abstract

“…Finally, in recent years different new techniques have been developed, improved, and validated for non-invasive CO monitoring, ranging from bioreactance [ 64 ] to plethysmography [ 65 , 66 ], which may be optimal for the ED setting. It should be noticed that inferior vena cava variations must not be used to assess preload responsiveness or response to fluid administration in spontaneously breathing patients [ 67 ].…”

Section: Monitoringmentioning

confidence: 99%

Management of sepsis and septic shock in the emergency department

2021

View full text Add to dashboard Cite

Early management of sepsis and septic shock is crucial for patients’ prognosis. As the Emergency Department (ED) is the place where the first medical contact for septic patients is likely to occur, emergency physicians play an essential role in the early phases of patient management, which consists of accurate initial diagnosis, resuscitation, and early antibiotic treatment. Since the issuing of the Surviving Sepsis Campaign guidelines in 2016, several studies have been published on different aspects of sepsis management, adding a substantial amount of new information on the pathophysiology and treatment of sepsis and septic shock. In light of this emerging evidence, the present narrative review provides a comprehensive account of the recent advances in septic patient management in the ED.

show abstract

Diagnostic accuracy of inferior vena caval respiratory variation in detecting fluid unresponsiveness

Abstract: CRD 42017068028.

Cited by 24 publications

References 30 publications

Do changes in pulse pressure variation and inferior vena cava distensibility during passive leg raising and tidal volume challenge detect preload responsiveness in case of low tidal volume ventilation?

Do changes in pulse pressure variation and inferior vena cava distensibility during passive leg raising and tidal volume challenge detect preload responsiveness in case of low tidal volume ventilation?

Caudal vena cava collapsibility index as a tool to predict fluid responsiveness in dogs

Management of sepsis and septic shock in the emergency department

Contact Info

Product

Resources

About