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. 2017 May 20;130(10):1202-1210.
doi: 10.4103/0366-6999.205848.

Monitoring Changes in Hepatic Venous Velocities Flow after a Fluid Challenge Can Identify Shock Patients Who Lack Fluid Responsiveness

Wei Du  1 , Xiao-Ting Wang  1 , Yun Long  1 , Da-Wei Liu  1
Affiliations

Monitoring Changes in Hepatic Venous Velocities Flow after a Fluid Challenge Can Identify Shock Patients Who Lack Fluid Responsiveness

Wei Du et al. Chin Med J (Engl). .

Abstract

Background: Evaluating the hemodynamic status and predicting fluid responsiveness are important in critical ultrasound assessment of shock patients. Transthoracic echocardiography with noninvasive diagnostic parameters allows the assessment of volume responsiveness. This study aimed to assess the hemodynamic changes in the liver and systemic hemodynamic changes during fluid challenge and during passive leg raising (PLR) by measuring hepatic venous flow (HVF) velocity.

Methods: This is an open-label study in a tertiary teaching hospital. Shock patients with hypoperfusion who required fluid challenge were selected for the study. Patients <18 years old and those with contraindications to PLR were excluded from the study. Baseline values were measured, PLR tests were performed, and 500 ml of saline was infused over 30 min. Parameters associated with cardiac output (CO) in the left ventricular outflow tract were measured using the Doppler method. In addition, HVF velocity and right ventricular function parameters were determined.

Results: Middle hepatic venous (MHV) S-wave velocity was positively correlated in all patients with CO at baseline (r = 0.706, P< 0.01) and after volume expansion (r = 0.524, P= 0.003). CO was also significantly correlated with MHV S-wave velocity in responders (r = 0.608, P< 0.01). During PLR, however, hepatic venous S-wave velocity did not correlate with CO. For the parameter ΔMHV D (increase in change in MHV D-wave velocity after volume expansion), defined as (MHV DafterVE - MHV DBaseline)/MHV DBaseline× 100%, >21% indicated no fluid responsiveness, with a sensitivity of 100%, a specificity of 71.2%, and an area under the receiver operating characteristic curve of 0.918.

Conclusions: During fluid expansion, hepatic venous S-wave velocity can be used to monitor CO, whether or not it is increasing. ΔMHV D ≥21% indicated a lack of fluid responsiveness, thus helping to decide when to stop infusions.

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Conflict of interest statement

There are no conflicts of interest.

Figures

Figure 1
Figure 1
The test flow chart of this study. PLR: Passive leg raising; VE: Volume expansion; CO: Cardiac output; HVF: Hepatic venous flow; RV function: Right ventricular function.
Figure 2
Figure 2
ROC curve analysis showing the relationship between CO and ΔMHV D. ΔMHV D was able to accurately detect <15% increase in CO on ROC curve analysis. ΔMHV D >21% was associated with no increase in CO during volume expansion, with a sensitivity of 100%, a specificity of 71%, and an AUC of 0.918. MHV DafterVE >31.4 cm/s was associated with no increase in CO during volume expansion, with a sensitivity of 73%, a specificity of 84%, and an AUC of 0.772. CO: Cardiac output; AUC: Area under the curve; ROC: Receiver operating characteristic; MHV: Middle hepatic venous.
Figure 3
Figure 3
The hepatic vein waveform obtained in baseline and after volume expansion. (a) The patient who has fluid responsiveness: The S-wave increased with volume expansion. (b) The patient who lack fluid responsiveness: The D-wave increased with volume expansion, and the ΔMHV D, calculated as (38.4 − 17.4)/17.4 × 100% = 121%, far more than 21% as this study shows. MHV: Middle hepatic venous.
See this image and copyright information in PMC

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