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Limited value of end-expiratory inferior vena cava diameter to predict fluid responsiveness impact of intra-abdominal pressure.
- Source :
-
Intensive care medicine [Intensive Care Med] 2018 Feb; Vol. 44 (2), pp. 197-203. Date of Electronic Publication: 2018 Jan 22. - Publication Year :
- 2018
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Abstract
- Purpose: We sought to determine the diagnostic ability of the end-expiratory inferior vena cava diameter (IVC <subscript>EE</subscript> ) to predict fluid responsiveness (FR) and the potential confounding effect of intra-abdominal pressure (IAP).<br />Methods: In this multicenter study, 540 consecutive ventilated patients with shock of various origins underwent an echocardiographic assessment by experts. The IVC <subscript>EE</subscript> , velocity time integral (VTI) of the left ventricular outflow tract (LVOT) and intra-abdominal pressure (IAP) were measured. Passive leg raising (PLR) was then systematically used to perform a reversible central blood volume expansion. FR was defined by an increase in LVOT VTI ≥ 10% after 1 min of PLR.<br />Results: Since IVC <subscript>EE</subscript> was not obtained in 117 patients (22%), 423 were studied (septic shock: 56%), 129 of them (30%) having elevated IAP (≥ 12 mmHg) and 172 of them (41%) exhibiting FR. IVC <subscript>EE</subscript>  ≤ 13 mm predicted FR with a specificity of at least 80% in 62 patients (15%), while IVC <subscript>EE</subscript>  ≥ 25 mm predicted the absence of FR with a specificity of at least 80% in 61 patients (14%). In the remaining 300 patients (71%), the intermediate value of IVC <subscript>EE</subscript> did not allow predicting FR. An adjusted relationship between IVC <subscript>EE</subscript> and FR was observed while this relationship was less pronounced in patients with IAP ≥ 12 mmHg.<br />Conclusions: Measurement of IVC <subscript>EE</subscript> in ventilated patients is moderately feasible and poorly predicts FR, with IAP acting as a confounding factor. IVC <subscript>EE</subscript> might add some value to guide fluid therapy but should not be used alone for fluid prediction purposes.
Details
- Language :
- English
- ISSN :
- 1432-1238
- Volume :
- 44
- Issue :
- 2
- Database :
- MEDLINE
- Journal :
- Intensive care medicine
- Publication Type :
- Academic Journal
- Accession number :
- 29356854
- Full Text :
- https://doi.org/10.1007/s00134-018-5067-2