Respiratory variation in aortic flow peak velocity and inferior vena cava distensibility as indices of fluid responsiveness in anaesthetised and mechanically ventilated children

Abstract

Background and Aims:Dynamic parameters such as the respiratory variation in aortic flow peak velocity (ΔVpeak) and inferior vena cava distensibility index (dIVC) are accurate indices of fluid responsiveness in adults. Little is known about their utility in children. We studied the ability of these indices to predict fluid responsiveness in anaesthetised and mechanically ventilated children.Methods:This prospective study was conducted in 42 children aged between one to 14 years scheduled for elective surgery under general endotracheal anaesthesia. Mechanical ventilation was initiated with a tidal volume of 10 ml/kg. ΔVpeak, dIVC and stroke volume index (SVI) were measured before and after volume expansion (VE) with 10 ml/kg of crystalloid using transthoracic echocardiography. Patients were considered to be responders (R) and non-responders (NR) when SVI increased to either ≥15% or <15% after VE. ΔVpeak and dIVC were analysed between R and NR.Results:The best cut-off value for ΔVpeak as defined by the receiver operator characteristics (ROC) curve analysis was 12.2%, for which sensitivity, specificity, positive predictive value and negative predictive value were 100%, 94%, 96% and 100%, respectively, the area under the curve was 0.975. The best cut-off value for dIVC as defined by the ROC curve analysis was 23.5%, for which sensitivity, specificity, positive predictive value and negative predictive value were 91%, 89%, 91% and 89%, respectively, the area under the curve was 0.95.Conclusion:ΔVpeak and dIVC are reliable indices of fluid responsiveness in children.

Value of respiratory variation of aortic peak velocity in predicting children receiving mechanical ventilation: a systematic review and meta-analysis

“…5Scatter plot of cutoff value of respiratory variation of aortic peak velocity in included studies. The cutoff values of included studies are as follows: (1) Durand 2008 [30], 12%; (2) Choi 2010 [31], 20%; (3) Renner 2011 [32], 7%; (4) Pereira 2011 [33], 10%; (5) Byon 2013 [34], 11%; (6) Lee 2014 [35], 14%; (7) Lee 2015 [36], 13.5%; (8) Krishna 2016 [37], 12.2%; (9) Favia 2017 [38], 16.5%; (10) Lee 2017 [39], 12%; (11) Morparia 2018 [40], 12.3%…”

Role of ultrasonographic inferior venacaval assessment in averting spinal anaesthesia-induced hypotension for hernia and hydrocele surgeries—A prospective randomised controlled study

“…[ 12 ] IVCUS assessment is a better tool compared to MAP, HR, and CVP measurements for induction in operating room area and used as a perioperative screening and monitoring tool. [ 2 13 ] In the present study, we identified fluid responders using IVCCI cutoff value <36% and performed volume optimisation before spinal anaesthesia. This cutoff value was taken from study done by Zhang et al .…”

Comparison of inferior vena cava collapsibility, distensibility, and delta indices at different positive pressure supports and prediction values of indices for intravascular volume status

“…This difference and the study results led us to the consideration that the cut-off value for the dIVC may be determined as higher than 18%. Achar et al, in a study of a pediatric population, determined that the dIVC cut-off value for responsive and non-responsive patients was 23.5%, and with the ΔIVC they determined it as 12.2% [5]. Duwat et al stated that there was a gray zone for dIVC cut-off values (15%-30%) with sensitivity and specificity that was better for values below 15% and above 30% [17].…”