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. 2018 Aug 2;8(1):79.
doi: 10.1186/s13613-018-0427-1.

Respiratory changes of the inferior vena cava diameter predict fluid responsiveness in spontaneously breathing patients with cardiac arrhythmias

Perrine Bortolotti  1   2 , Delphine Colling  3   4 , Vincent Colas  4 , Benoit Voisin  3 , Florent Dewavrin  4 , Julien Poissy  3 , Patrick Girardie  3 , Maeva Kyheng  5 , Fabienne Saulnier  3 , Raphael Favory  3 , Sebastien Preau  3   6
Affiliations

Respiratory changes of the inferior vena cava diameter predict fluid responsiveness in spontaneously breathing patients with cardiac arrhythmias

Perrine Bortolotti et al. Ann Intensive Care. .

Abstract

Background: Whether the respiratory changes of the inferior vena cava diameter during a deep standardized inspiration can reliably predict fluid responsiveness in spontaneously breathing patients with cardiac arrhythmia is unknown.

Methods: This prospective two-center study included nonventilated arrhythmic patients with infection-induced acute circulatory failure. Hemodynamic status was assessed at baseline and after a volume expansion of 500 mL 4% gelatin. The inferior vena cava diameters were measured with transthoracic echocardiography using the bi-dimensional mode on a subcostal long-axis view. Standardized respiratory cycles consisted of a deep inspiration with concomitant control of buccal pressures and passive exhalation. The collapsibility index of the inferior vena cava was calculated as [(expiratory-inspiratory)/expiratory] diameters.

Results: Among the 55 patients included in the study, 29 (53%) were responders to volume expansion. The areas under the ROC curve for the collapsibility index and inspiratory diameter of the inferior vena cava were both of 0.93 [95% CI 0.86; 1]. A collapsibility index ≥ 39% predicted fluid responsiveness with a sensitivity of 93% and a specificity of 88%. An inspiratory diameter < 11 mm predicted fluid responsiveness with a sensitivity of 83% and a specificity of 88%. A correlation between the inspiratory effort and the inferior vena cava collapsibility was found in responders but was absent in nonresponder patients.

Conclusions: In spontaneously breathing patients with cardiac arrhythmias, the collapsibility index and inspiratory diameter of the inferior vena cava assessed during a deep inspiration may be noninvasive bedside tools to predict fluid responsiveness in acute circulatory failure related to infection. These results, obtained in a small and selected population, need to be confirmed in a larger-scale study before considering any clinical application.

Keywords: Arrhythmia; Atrial fibrillation; Echocardiography; Fluid responsiveness; Hemodynamic; Inferior vena cava; Sepsis; Ultrasound.

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Figures

Fig. 1
Fig. 1
Scatterplot of individual values before volume expansion (VE) for the collapsibility index (cIVC-st), minimum-inspiratory diameter (iIVC-st) and the end-expiratory diameter (eIVC-st) of the inferior vena cava under standardized breathing in responders and nonresponders to VE
Fig. 2
Fig. 2
Linear correlation of the delta of collapsibility index of the inferior vena cava (∆cIVC) between standardized and spontaneous unstandardized breathing, and a the delta of inspiratory buccal pressure (∆Pinsp), and b the delta of diaphragmatic inspiratory excursion (∆DiaphExc) in responders. Linear correlation of ∆cIVC between standardized and spontaneous breathing, and c ∆Pinsp, and d ∆DiaphExc in nonresponders
Fig. 3
Fig. 3
Linear correlation of the delta of the inspiratory diameter of the inferior vena cava (∆iIVC) between standardized and spontaneous unstandardized breathing, and a the delta of inspiratory buccal pressure (∆Pinsp), and b the delta of diaphragmatic inspiratory excursion (∆DiaphExc) in responders. Linear correlation of ∆iIVC between standardized and spontaneous unstandardized breathing, and c ∆Pinsp, and d ∆DiaphExc in nonresponders
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