Ultrasound assessment of the inferior vena cava for fluid responsiveness: easy, fun, but unlikely to be helpful

Utility of Doppler ultrasound derived hepatic and portal venous waveforms in the management of heart failure exacerbation

“…For example, the vessel is routinely measured in its long axis (anteroposterior diameter) but the inspiratory collapse can occur craniocaudally and also mediolaterally resulting in errors. 10 In addition, one must be vigilant about anatomic factors leading to false collapse such as diaphragm compressing the IVC. 11 Furthermore, the changes in the size of the IVC depend on variations in intrathoracic pressure and lung compliance.…”

Perioperative Quality Initiative (POQI) consensus statement on fundamental concepts in perioperative fluid management: fluid responsiveness and venous capacitance

“…While ultrasonographic evaluation of vena cava diameter, distensibility, and collapsibility are increasingly used in emergency medicine and critical care, its use has numerous confounders (right heart dysfunction, obstructive cardiac physiology, transpulmonary and intraabdominal pressure, mode of ventilatory support) and is not currently supported by evidence in the perioperative setting (Millington, 2019;Via et al, 2016). Finally, it is important to note that fluid bolus therapy rapidly impacts the macrocirculation but does not necessarily alter the microcirculation or cellular function, especially during the short time frame used to assess fluid responsiveness.…”

In reply: Is ultrasound assessment of the inferior vena cava for fluid responsiveness unlikely to be helpful, or is it just too early to say?

“…To the Editor, I thank Drs Li, Yin, and Kang for their comment 1 on my article. 2 I am pleased to see a vigorous debate on this important issue. This is an area where reasonable people can disagree, and we certainly seem to have found healthy disagreement here.…”