Diagnostic Accuracy of the Inferior Vena Cava Collapsibility to Predict Fluid Responsiveness in Spontaneously Breathing Patients With Sepsis and Acute Circulatory Failure
| Autor: | Florent Dewavrin, Elodie Drumez, Fabienne Saulnier, Alain Durocher, Thierry Onimus, Delphine Colling, Perrine Bortolotti, Benoit Voisin, Sebastien Preau, Vincent Colas, Alban Redheuil |
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| Rok vydání: | 2017 |
| Předmět: |
Adult
Male medicine.medical_treatment Hemodynamics Vena Cava Inferior 030204 cardiovascular system & hematology Critical Care and Intensive Care Medicine Inferior vena cava 03 medical and health sciences 0302 clinical medicine Predictive Value of Tests Sepsis medicine Humans Prospective Studies Vein Aged Mechanical ventilation business.industry Exhalation Shock Stroke Volume 030208 emergency & critical care medicine Stroke volume Middle Aged Water-Electrolyte Balance medicine.anatomical_structure Inhalation ROC Curve medicine.vein Echocardiography Area Under Curve Anesthesia Predictive value of tests Breathing Fluid Therapy Female business |
| Zdroj: | ResearcherID |
| ISSN: | 0090-3493 |
| DOI: | 10.1097/ccm.0000000000002090 |
| Popis: | Objective To investigate whether the collapsibility index of the inferior vena cava recorded during a deep standardized inspiration predicts fluid responsiveness in nonintubated patients. Design Prospective, nonrandomized study. Setting ICUs at a general and a university hospital. Patients Nonintubated patients without mechanical ventilation (n = 90) presenting with sepsis-induced acute circulatory failure and considered for volume expansion. Interventions We assessed hemodynamic status at baseline and after a volume expansion induced by a 30-minute infusion of 500-mL gelatin 4%. Measurements and main results We measured stroke volume index and collapsibility index of the inferior vena cava under a deep standardized inspiration using transthoracic echocardiography. Vena cava pertinent diameters were measured 15-20 mm caudal to the hepatic vein junction and recorded by bidimensional imaging on a subcostal long-axis view. Standardized respiratory cycles consisted of a deep standardized inspiration followed by passive exhalation. The collapsibility index expressed in percentage equaled the ratio of the difference between end-expiratory and minimum-inspiratory diameter over the end-expiratory diameter. After volume expansion, a relevant (≥ 10%) stroke volume index increase was recorded in 56% patients. In receiver operating characteristic analysis, the area under curve for that collapsibility index was 0.89 (95% CI, 0.82-0.97). When such index is superior or equal to 48%, fluid responsiveness is predicted with a sensitivity of 84% and a specificity of 90%. Conclusions The collapsibility index of the inferior vena cava during a deep standardized inspiration is a simple, noninvasive bedside predictor of fluid responsiveness in nonintubated patients with sepsis-related acute circulatory failure. |
| Databáze: | OpenAIRE |
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