Ultrasonographic Measurement of the Respiratory Variation in the Inferior Vena Cava Diameter Is Predictive of Fluid Responsiveness in Critically Ill Patients: Systematic Review and Meta-analysis

Abstract

Respiratory variation in the inferior vena cava (ΔIVC) has been extensively studied with respect to its value in predicting fluid responsiveness, but the results are conflicting. This systematic review was aimed at investigating the diagnostic accuracy of ΔIVC in predicting fluid responsiveness. Databases including Medline, Embase, Scopus and Web of Knowledge were searched from inception to May 2013. Studies exploring the diagnostic performance of ΔIVC in predicting fluid responsiveness were included. To allow for more between- and within-study variance, a hierarchical summary receiver operating characteristic model was used to pool the results. Subgroup analyses were performed for patients on mechanical ventilation, spontaneously breathing patients and those challenged with colloids and crystalloids. A total of 8 studies involving 235 patients were eligible for analysis. Cutoff values of ΔIVC varied across studies, ranging from 12% to 40%. The pooled sensitivity and specificity in the overall population were 0.76 (95% confidence interval [CI]: 0.61-0.86) and 0.86 (95% CI: 0.69-0.95), respectively. The pooled diagnostic odds ratio (DOR) was 20.2 (95% CI: 6.1-67.1). The diagnostic performance of ΔIVC appeared to be better in patients on mechanical ventilation than in spontaneously breathing patients (DOR: 30.8 vs. 13.2). The pooled area under the receiver operating characteristic curve was 0.84 (95% CI: 0.79-0.89). Our study indicates that ΔIVC measured with point-of-care ultrasonography is of great value in predicting fluid responsiveness, particularly in patients on controlled mechanical ventilation and those resuscitated with colloids.

Influence of breathing movements and Valsalva maneuver on vena caval dynamics

“…Some studies have attempted to relate the biometrics of the IVC with various clinical applications, especially in the field of IVC filters [12,14,15,23] and as an indirect assessment of intravascular volume [14,[24][25][26] . The majority of authors against migration, as two projections are not adequate to evaluate filter anchoring to the vein wall.…”

Якісна Клінічна Практика Стартової Інтенсивної Терапії При Бойовій І Цивільній Політравмі (Огляд Літератури)

“…Это обеспечи-вает возможность контроля жидкостной реанима-ции в режиме реального времени. Наиболее широко используемый метод оценки отклика на инфузию жидкости -кавальный индекс с использованием параметров нижней полой вены [61]. Это измерение является наиболее полезным при экстремальных из-менениях объемного статуса и находится под влияни-ем увеличения параметров вентиляции (дыхательный объем и ПДКВ) и внутрибрюшного давления.…”

Advances in photoplethysmography: beyond arterial oxygen saturation

“…11,68,69 This information, along with the dependence of PVI on signal quality, may explain why arterial and PPG-based estimates of respiratory variation do not correlate well. Despite the poor correlation with PPV, PVI seems to be fairly predictive of fluid responsiveness, at least at tidal volumes above 8 mLÁkg -1 .…”

“…That said, there are data to suggest that venous oscillations (i.e., as measured in the inferior vena cava via ultrasound) are predictive of fluid responsiveness. 68 Even more interesting, Alian et al recorded the peripheral venous pressure waveform during simulated hypovolemia (lower body negative pressure [LBNP]) and found an increase in spectral power at the respiratory frequency at moderate levels of LBNP, followed by near complete abolition of respiratory variation at LBNP levels leading to symptoms. 69 This suggests that there are complex interactions between the systemic arterial and venous systems in the setting of hypovolemia.…”