Respiratory variations of inferior vena cava diameter to predict fluid responsiveness in spontaneously breathing patients with acute circulatory failure: need for a cautious use

Laurent Muller, Xavier Bobbia, Mehdi Toumi, Guillaume Louart, Nicolas Molinari, Benoit Ragonnet, Hervé Quintard, Marc Leone, Lana Zoric, Jean Yves Lefrant, AzuRea group, Laurent Muller, Xavier Bobbia, Mehdi Toumi, Guillaume Louart, Nicolas Molinari, Benoit Ragonnet, Hervé Quintard, Marc Leone, Lana Zoric, Jean Yves Lefrant, AzuRea group

Abstract

Introduction: To investigate whether respiratory variation of inferior vena cava diameter (cIVC) predict fluid responsiveness in spontaneously breathing patients with acute circulatory failure (ACF).

Methods: Forty patients with ACF and spontaneous breathing were included. Response to fluid challenge was defined as a 15% increase of subaortic velocity time index (VTI) measured by transthoracic echocardiography. Inferior vena cava diameters were recorded by a subcostal view using M Mode. The cIVC was calculated as follows: (Dmax - Dmin/Dmax) × 100 and then receiver operating characteristic (ROC) curves were generated for cIVC, baseline VTI, E wave velocity, E/A and E/Ea ratios.

Results: Among 40 included patients, 20 (50%) were responders (R). The causes of ACF were sepsis (n = 24), haemorrhage (n = 11), and dehydration (n = 5). The area under the ROC curve for cIVC was 0.77 (95% CI: 0.60-0.88). The best cutoff value was 40% (Se = 70%, Sp = 80%). The AUC of the ROC curves for baseline E wave velocity, VTI, E/A ratio, E/Ea ratio were 0.83 (95% CI: 0.68-0.93), 0.78 (95% CI: 0.61-0.88), 0.76 (95% CI: 0.59-0.89), 0.58 (95% CI: 0.41-0.75), respectively. The differences between AUC the ROC curves for cIVC and baseline E wave velocity, baseline VTI, baseline E/A ratio, and baseline E/Ea ratio were not statistically different (p = 0.46, p = 0.99, p = 1.00, p = 0.26, respectively).

Conclusion: In spontaneously breathing patients with ACF, high cIVC values (>40%) are usually associated with fluid responsiveness while low values (< 40%) do not exclude fluid responsiveness.

Figures

Figure 1
Figure 1
Individual values of inferior vena cava collapsibility (cIVC) (%) after infusion of 500 mL of HES. The best cutoff value is 40%.
Figure 2
Figure 2
Receiver operator characteristic (ROC) curve for inferior vena cava collapsibility (cIVC) (%) after infusion of 500 mL of HES. Area under the ROC curve was 0.77 (95% CI 0.60, 0.88).

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