Inferior vena cava distensibility during pressure support ventilation: a prospective study evaluating interchangeability of subcostal and trans‑hepatic views, with both M‑mode and automatic border tracing

Abstract

The Inferior Vena Cava (IVC) is commonly utilized to evaluate fluid status in the Intensive Care Unit (ICU),with more recent emphasis on the study of venous congestion. It is predominantly measured via subcostal approach (SC) or trans-hepatic (TH) views, and automated border tracking (ABT) software has been introduced to facilitate its assessment. Prospective observational study on patients ventilated in pressure support ventilation (PSV) with 2 × 2 factorial design. Primary outcome was to evaluate interchangeability of measurements of the IVC and the distensibility index (DI) obtained using both M-mode and ABT, across both SC and TH. Statistical analyses comprised Bland-Altman assessments for mean bias, limits of agreement (LoA), and the Spearman correlation coefficients. IVC visualization was 100% successful via SC, while TH view was unattainable in 17.4% of cases. As compared to the M-mode, the IVC-DI obtained through ABT approach showed divergences in both SC (mean bias 5.9%, LoA -18.4% to 30.2%, ICC = 0.52) and TH window (mean bias 6.2%, LoA -8.0% to 20.4%, ICC = 0.67). When comparing the IVC-DI measures obtained in the two anatomical sites, accuracy improved with a mean bias of 1.9% (M-mode) and 1.1% (ABT), but LoA remained wide (M-mode: -13.7% to 17.5%; AI: -19.6% to 21.9%). Correlation was generally suboptimal (r = 0.43 to 0.60). In PSV ventilated patients, we found that IVC-DI calculated with M-mode is not interchangeable with ABT measurements. Moreover, the IVC-DI gathered from SC or TH view produces not comparable results, mainly in terms of precision.

Keywords: Artificial intelligence; Correlation; Echocardiography; Fluid responsiveness; Vexus.

Fig. 1

Bland–Altman plot depicting the distensibility index (DI) of the inferior vena cava obtained at the subcostal site, using standard M-mode (SC-M) and artificial intelligence (SC-ABT)

Fig. 2

Bland–Altman plot depicting the distensibility index (DI) of the inferior vena cava obtained at the transhepatic site, using standard M-mode (TH-M) and artificial intelligence (TH-ABT)

Fig. 3

Bland–Altman plot depicting the distensibility index (DI) of the inferior vena cava obtained with standard M-mode, at two different sites: subcostal (SC-M) and transhepatic (TH-M)

Fig. 4

Bland–Altman plot depicting the distensibility index (DI) of the inferior vena cava obtained with artificial intelligence mode, at two different sites: subcostal (SC-ABT) and transhepatic (TH-ABT)