Inferior Vena Cava Respiratory Variations: A Useful Tool at Bedside to Guide Fluid Therapy in Spontaneously Breathing Patients

Bortolotti, Perrine; Colling, Delphine; Preau, Sébastien

doi:10.1097/shk.0000000000000950

Cited by 8 publications

(10 citation statements)

References 7 publications

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“…3 IVC variability by ultrasound allows a dynamic non-invasive point-of-care estimate of relative intravascular volume. Greater IVC variation predicts an increase in cardiac output in response to volume administration in patients with relative intravascular volume depletion with reasonable sensitivity and specificity, 3,4,[6][7][8] and lesser variation is associated with the ability to remove volume by ultrafiltration 9 or to increase cardiac output in response to volume removal 10 in kidney disease patients with relative intravascular volume overload.…”

Section: Introductionmentioning

confidence: 99%

<p>Comparison of Respiratory Variations of Subclavian Vein and Inferior Vena Cava in Hospitalized Patients with Kidney Disease</p>

Kaptein¹,

Cantillep²,

Kaptein³

et al. 2020

IJNRD

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Background Accurate assessment of relative intravascular volume is critical for appropriate volume management of patients with kidney disease. Respiratory variations of inferior vena cava (IVC) diameter have been used and may correlate with those of subclavian vein (SCV) by bedside ultrasound. The purpose of this study was to assess the relationship between SCV and IVC respiratory variations by bedside ultrasound in a large group of hospitalized patients with acute and/or chronic kidney disease. Methods We compared 160 paired SCV and IVC bedside ultrasound studies from 102 semi-recumbent hospitalized adult patients with kidney disease. Patient encounters in which the SCV or IVC could not be clearly visualized were excluded. Collapsibility index=(Dmax–Dmin)/Dmax*100%; D=venous diameter. Results Relationships between SCV collapsibility index and IVC collapsibility index were not different for longitudinal and transverse views of the SCV. Correlation of SCV collapsibility index with IVC collapsibility index was 0.75 for mechanical ventilation (n=65, P<0.0001) and 0.67 for spontaneous breathing (n=95, P<0.0001). IVC collapsibility index cut-offs <20% for hypervolemia and >50% for hypovolemia corresponded to SCV collapsibility index cut-offs of <22% and >39%, respectively, for both mechanical ventilation and spontaneous breathing encounters. Using these cut-offs for SCV collapsibilities, assessment as hypervolemia versus not-hypervolemia had maximal sensitivity and specificity for predicting respective IVC collapsibility cut-offs of 88% for mechanical ventilation and 74% for spontaneous breathing, and assessment as hypovolemia versus not-hypovolemia had maximal sensitivity and specificity of 91% and 70%, respectively. Concordance, defined as agreement between assessment using SCV CI and assessment using IVC CI, was 85% for mechanical ventilation and 72% for spontaneous breathing when differentiating hypervolemia versus not-hypervolemia and was 89% and 71% respectively when differentiating hypovolemia versus not-hypovolemia. Conclusion Assessment using SCV collapsibility index in the semi-recumbent position has a reasonable concordance with assessment using IVC collapsibility index for both spontaneous breathing and mechanical ventilation, in a wide range of hospitalized patients with concurrent kidney disease, and may be a useful adjunct to assess relative intravascular volume in patients with kidney disease.

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Section: Introductionmentioning

confidence: 99%

<p>Comparison of Respiratory Variations of Subclavian Vein and Inferior Vena Cava in Hospitalized Patients with Kidney Disease</p>

Kaptein¹,

Cantillep²,

Kaptein³

et al. 2020

IJNRD

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show abstract

“…Second, it is desirable that ultrasonography for IVC assessment should be performed under standardized respiratory conditions in order to obtain accurate values of IVCD. 29,30 The measured values of IVCD parameters in this study might have been affected by variations in respiratory conditions in the three postures in each patient, even though we urged all patients to hold their steady breathing during ultrasonography in all three postures.…”

Section: Discussionmentioning

confidence: 94%

“…Since it is possible that the effect of each posture on IVCD, as described in the study, might be different in patients under spinal anesthesia, the part of our discussion related to the effects of these postures on IVCD under spinal anesthesia is only speculative. Second, it is desirable that ultrasonography for IVC assessment should be performed under standardized respiratory conditions in order to obtain accurate values of IVCD 29,30 . The measured values of IVCD parameters in this study might have been affected by variations in respiratory conditions in the three postures in each patient, even though we urged all patients to hold their steady breathing during ultrasonography in all three postures.…”

Section: Discussionmentioning

confidence: 96%

Preanesthetic ultrasonography assessment of inferior vena cava diameter in the supine position, left lateral tilt position, and with the left uterine displacement maneuver in full‐term pregnant women: A randomized cross‐over design study

Furuya

Hirose

Sato

et al. 2022

J of Obstet and Gynaecol

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Preanesthetic ultrasonography assessment of inferior vena cava diameter (IVCD) in the supine position (SP), left lateral tilt position (LLT), and with the left uterine displacement maneuver (LUD) in full‐term pregnant women: a randomized cross‐over design study.AimWe pre‐anesthetically measured IVCD using ultrasonography in the SP, LLT, and the LUD in full‐term pregnant women, using a cross‐over design, to evaluate the effectiveness of LLT and LUD on increasing IVCD, and the presence of inter‐individual differences among patients in the effect of posture on IVCD.MethodsTwenty‐two parturients scheduled for elective cesarean section under spinal anesthesia were recruited. All patients were sequentially placed in the SP, LLT, and with LUD before spinal anesthesia induction. Indices of IVCD, measured by subxiphoid ultrasonography, including maximum IVCD (IVCDmax), minimum IVCD (IVCDmin), and collapsibility index (CI) were recorded in each of the postures. Mean or median values of all measurements were compared among the postures.ResultsThe mean values of IVCDmax observed with both LLT and LUD were significantly larger than those in the SP, respectively (SP vs. LLT: p < 0.05, SP vs. LUD: p < 0.01), although there were no significant differences between IVCDmax with LLT and LUD. There were no significant differences in IVCDmin and CI between any of the postures. IVCDmax was highest with LUD in 11 patients (55%), in the LLT in seven patients (35%) and in the SP in two patients (10%).ConclusionsLLT and LUD might be equally effective in enlarging the narrowed IVCD as compared to SP. However, both LLT and LUD might not necessarily be appropriate treatments to relieve IVC compression in some cases.

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“…Considering that even a reduced cIVC may not rule out a fluid responsiveness or the need for fluid therapy, a cIVC threshold < 15% with the addition of a standardized inspiratory effort was proposed as an attempt to improve cIVC diagnostic accuracy [ 44 ].…”

Section: Evidence For Volaemic Status Evaluation With Ivc Ultrasonogr...mentioning

confidence: 99%

Inferior Vena Cava Ultrasonography for Volume Status Evaluation: An Intriguing Promise Never Fulfilled

Nicolò¹,

Tavazzi

Nannoni³

et al. 2023

JCM

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The correct determination of volume status is a fundamental component of clinical evaluation as both hypovolaemia (with hypoperfusion) and hypervolaemia (with fluid overload) increase morbidity and mortality in critically ill patients. As inferior vena cava (IVC) accounts for two-thirds of systemic venous return, it has been proposed as a marker of volaemic status by indirect assessment of central venous pressure or fluid responsiveness. Although ultrasonographic evaluation of IVC is relatively easy to perform, correct interpretation of the results may not be that simple and multiple pitfalls hamper its wider application in the clinical setting. In the present review, the basic elements of the pathophysiology of IVC behaviour, potential applications and limitations of its evaluation are discussed.

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Inferior Vena Cava Respiratory Variations: A Useful Tool at Bedside to Guide Fluid Therapy in Spontaneously Breathing Patients

Cited by 8 publications

References 7 publications

<p>Comparison of Respiratory Variations of Subclavian Vein and Inferior Vena Cava in Hospitalized Patients with Kidney Disease</p>

<p>Comparison of Respiratory Variations of Subclavian Vein and Inferior Vena Cava in Hospitalized Patients with Kidney Disease</p>

Preanesthetic ultrasonography assessment of inferior vena cava diameter in the supine position, left lateral tilt position, and with the left uterine displacement maneuver in full‐term pregnant women: A randomized cross‐over design study

Inferior Vena Cava Ultrasonography for Volume Status Evaluation: An Intriguing Promise Never Fulfilled

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