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. 2015 Nov 13:19:400.
doi: 10.1186/s13054-015-1100-9.

Does inferior vena cava respiratory variability predict fluid responsiveness in spontaneously breathing patients?

Norair Airapetian  1   2 , Julien Maizel  3   4 , Ola Alyamani  5 , Yazine Mahjoub  6   7 , Emmanuel Lorne  8   9 , Melanie Levrard  10 , Nacim Ammenouche  11 , Aziz Seydi  12 , François Tinturier  13 , Eric Lobjoie  14 , Hervé Dupont  15   16 , Michel Slama  17   18
Affiliations

Does inferior vena cava respiratory variability predict fluid responsiveness in spontaneously breathing patients?

Norair Airapetian et al. Crit Care. .

Abstract

Introduction: We have almost no information concerning the value of inferior vena cava (IVC) respiratory variations in spontaneously breathing ICU patients (SBP) to predict fluid responsiveness.

Methods: SBP with clinical fluid need were included prospectively in the study. Echocardiography and Doppler ultrasound were used to record the aortic velocity-time integral (VTI), stroke volume (SV), cardiac output (CO) and IVC collapsibility index (cIVC) ((maximum diameter (IVCmax)- minimum diameter (IVCmin))/ IVCmax) at baseline, after a passive leg-raising maneuver (PLR) and after 500 ml of saline infusion.

Results: Fifty-nine patients (30 males and 29 females; 57 ± 18 years-old) were included in the study. Of these, 29 (49 %) were considered to be responders (≥10 % increase in CO after fluid infusion). There were no significant differences between responders and nonresponders at baseline, except for a higher aortic VTI in nonresponders (16 cm vs. 19 cm, p = 0.03). Responders had a lower baseline IVCmin than nonresponders (11 ± 5 mm vs. 14 ± 5 mm, p = 0.04) and more marked IVC variations (cIVC: 35 ± 16 vs. 27 ± 10 %, p = 0.04). Prediction of fluid-responsiveness using cIVC and IVCmax was low (area under the curve for cIVC at baseline 0.62 ± 0.07; 95 %, CI 0.49-0.74 and for IVCmax at baseline 0.62 ± 0.07; 95 % CI 0.49-0.75). In contrast, IVC respiratory variations >42 % in SBP demonstrated a high specificity (97 %) and a positive predictive value (90 %) to predict an increase in CO after fluid infusion.

Conclusions: In SBP with suspected hypovolemia, vena cava size and respiratory variability do not predict fluid responsiveness. In contrast, a cIVC >42 % may predict an increase in CO after fluid infusion.

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Figures

Fig. 1
Fig. 1
Receiver operating characteristic curves for discriminating between volume expansion responders and nonresponders. ∆CO change in CO between baseline and after PLR, VCmax maximum inferior vena cava diameter at baseline, cIVC inferior vena cava collapsibility index at baseline, PLR passive leg raising
Fig. 2
Fig. 2
Inferior vena cava collapsibility index at baseline (expressed as a percentage) in responders and nonresponders. Individual values (open circles) and the mean ± SD per group (filled circles and solid lines). Se sensitivity, Sp specificity. * p <0.05 vs. nonresponders
Fig. 3
Fig. 3
Maximum inferior vena cava diameter at baseline in responders and nonresponders. Individual values (open circles) and the mean ± SD per group (filled circles and solid lines). Se sensitivity, Sp specificity. * p <0.05 vs. nonresponders
See this image and copyright information in PMC

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