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. 2023 Jul 10;11(1):40.
doi: 10.1186/s40635-023-00529-z.

Inferior vena cava distensibility from subcostal and trans-hepatic imaging using both M-mode or artificial intelligence: a prospective study on mechanically ventilated patients

Filippo Sanfilippo #  1   2 , Luigi La Via #  3   4 , Veronica Dezio  4 , Paolo Amelio  5 , Giulio Genoese  6 , Federico Franchi  7 , Antonio Messina  8   9 , Chiara Robba  10   11 , Alberto Noto  12
Affiliations

Inferior vena cava distensibility from subcostal and trans-hepatic imaging using both M-mode or artificial intelligence: a prospective study on mechanically ventilated patients

Filippo Sanfilippo et al. Intensive Care Med Exp. .

Abstract

Background: Variation of inferior vena cava (IVC) is used to predict fluid-responsiveness, but the IVC visualization with standard sagittal approach (SC, subcostal) cannot be always achieved. In such cases, coronal trans-hepatic (TH) window may offer an alternative, but the interchangeability of IVC measurements in SC and TH is not fully established. Furthermore, artificial intelligence (AI) with automated border detection may be of clinical value but it needs validation.

Methods: Prospective observational validation study in mechanically ventilated patients with pressure-controlled mode. Primary outcome was the IVC distensibility (IVC-DI) in SC and TH imaging, with measurements taken both in M-Mode or with AI software. We calculated mean bias, limits of agreement (LoA), and intra-class correlation (ICC) coefficient.

Results: Thirty-three patients were included. Feasibility rate was 87.9% and 81.8% for SC and TH visualization, respectively. Comparing imaging from the same anatomical site acquired with different modalities (M-Mode vs AI), we found the following IVC-DI differences: (1) SC: mean bias - 3.1%, LoA [- 20.1; 13.9], ICC = 0.65; (2) TH: mean bias - 2.0%, LoA [- 19.3; 15.4], ICC = 0.65. When comparing the results obtained from the same modality but from different sites (SC vs TH), IVC-DI differences were: (3) M-Mode: mean bias 1.1%, LoA [- 6.9; 9.1], ICC = 0.54; (4) AI: mean bias 2.0%, LoA [- 25.7; 29.7], ICC = 0.32.

Conclusions: In patients mechanically ventilated, AI software shows good accuracy (modest overestimation) and moderate correlation as compared to M-mode assessment of IVC-DI, both for SC and TH windows. However, precision seems suboptimal with wide LoA. The comparison of M-Mode or AI between different sites yields similar results but with weaker correlation. Trial registration Reference protocol: 53/2022/PO, approved on 21/03/2022.

Keywords: Critical care; Inferior vena cava; Subcostal; Transhepatic; Ultrasound.

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Conflict of interest statement

The authors declare no conflict of interests.

Figures

Fig. 1
Fig. 1
Bland–Altman plot for the inferior vena cava distensibility index (DI) measured in subcostal site with standard M-Mode (SC-M) or artificial intelligence (SC-AI). SD standard deviation
Fig. 2
Fig. 2
Bland–Altman plot for the inferior vena cava distensibility index (DI) measured in Transhepatic site with standard M-Mode (TH-M) or artificial intelligence (TH-AI). SD standard deviation
Fig. 3
Fig. 3
Bland–Altman plot for the inferior vena cava distensibility index (DI) measured with standard M-Mode in two different sites: subcostal (SC-M) and transhepatic (TH-M). SD standard deviation
Fig. 4
Fig. 4
Bland–Altman plot for the inferior vena cava distensibility index (DI) measured with artificial intelligence mode in two different sites: subcostal (SC-AI) and transhepatic (TH-AI). SD standard deviation
See this image and copyright information in PMC

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