Respiratory changes of the inferior vena cava diameter predict fluid responsiveness in spontaneously breathing patients with cardiac arrhythmias

Abstract

BackgroundWhether the respiratory changes of the inferior vena cava diameter during a deep standardized inspiration can reliably predict fluid responsiveness in spontaneously breathing patients with cardiac arrhythmia is unknown.MethodsThis prospective two-center study included nonventilated arrhythmic patients with infection-induced acute circulatory failure. Hemodynamic status was assessed at baseline and after a volume expansion of 500 mL 4% gelatin. The inferior vena cava diameters were measured with transthoracic echocardiography using the bi-dimensional mode on a subcostal long-axis view. Standardized respiratory cycles consisted of a deep inspiration with concomitant control of buccal pressures and passive exhalation. The collapsibility index of the inferior vena cava was calculated as [(expiratory–inspiratory)/expiratory] diameters.ResultsAmong the 55 patients included in the study, 29 (53%) were responders to volume expansion. The areas under the ROC curve for the collapsibility index and inspiratory diameter of the inferior vena cava were both of 0.93 [95% CI 0.86; 1]. A collapsibility index ≥ 39% predicted fluid responsiveness with a sensitivity of 93% and a specificity of 88%. An inspiratory diameter < 11 mm predicted fluid responsiveness with a sensitivity of 83% and a specificity of 88%. A correlation between the inspiratory effort and the inferior vena cava collapsibility was found in responders but was absent in nonresponder patients.ConclusionsIn spontaneously breathing patients with cardiac arrhythmias, the collapsibility index and inspiratory diameter of the inferior vena cava assessed during a deep inspiration may be noninvasive bedside tools to predict fluid responsiveness in acute circulatory failure related to infection. These results, obtained in a small and selected population, need to be confirmed in a larger-scale study before considering any clinical application.Electronic supplementary materialThe online version of this article (10.1186/s13613-018-0427-1) contains supplementary material, which is available to authorized users.

Association of inferior vena cava diameter ratio measured on computed tomography scans with the outcome of patients with septic shock

“…[ 12 , 13 ] Recently published studies have claimed that even in patients with spontaneous breathing, this value can help in determining the volume status. [ 14 ] Moreover, it has been reported that the absolute value of the IVC diameter can predict the volume status. [ 15 ] In trauma patients, the diameter of the IVC measured on a computed tomography (CT) scan has been reported to be associated with the prognosis.…”

Role of inferior vena cava collapsibility index in the prediction of hypotension associated with general anesthesia: an observational study

“…Second, spontaneous breathing is difficult to standardize, and we hypothesized that premedicated patients without obvious signs of agitation (RASS≤1) and respiratory efforts constitute an adequate setting for IVC measurements. Our protocol tends to follow physiologic airway pressure changes but therefore differs from that of some cited studies, which chose forced deep inspiration [15] or sniffing [14] [16]. Additionally, our study, by its observational nature, is not entirely free from intergroup differences: patients in the CI+ group were slightly older than those in the CI-group (median 69 vs 61 years.).…”

“…However, a French center reported that parameters of high anesthesiological importance such as global left ventricular function, ventricular diameters, pericardial effusion or the diameter of the inferior vena cava were adequately evaluated by trainees who had taken part in a 12 hour learning program [9]. Concerning volemic status, the variability of the diameter of the inferior vena cava (IVC), which follows the respiratory cycle, is considered to be a valuable predictor of volume responsiveness in cases of circulatory failure in ventilated [10] [11] [12] [13] and spontaneously breathing patients [14] [15] even in the presence of nonfatal cardiac arrhythmias [16]. In these studies, clinically evident volume responsiveness was defined as an at least 10% increase in cardiac output in response to bolus fluid administration.…”

Systematic assessment of fluid responsiveness during early septic shock resuscitation: secondary analysis of the ANDROMEDA-SHOCK trial

“…A decision algorithm was proposed to guide FR assessment in complex cases (Additional file 1). Only tests with a validated cutoff for a 10-15% increase in CO after a fluid challenge were allowed [13,14,17,33,34]. A detailed description of each used test including its cutoffs is presented in Additional file 2.…”

“…They allow to determine the position of the patient's heart on its systolic function curve. By applying the appropriate tests, FR can be assessed in a wide variety of clinical settings [16][17][18]. However, despite their relative simplicity, lack of cost, and side effects, the use of FR tests has not completely permeated into routine clinical practice [19,20].…”