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Accuracy of Respiratory Variation in Inferior Vena Cava Diameter to Predict Fluid Responsiveness in Children Under Mechanical Ventilation

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Abstract

Proper assessment of fluid responsiveness using accurate predictors is crucial to guide fluid therapy and avoid the serious adverse effects of fluid overload. The main objective of this study was to investigate the accuracy of respiratory variations in inferior vena cava diameter (∆IVC) to predict fluid responsiveness in mechanically ventilated children. This prospective single-center study included 32 children (median age and weight of 17 months and 10 kg, respectively) who received a fluid infusion of 10 ml kg–1 of crystalloid solutions over 10 min. ∆IVC and respiratory variation in aortic blood flow peak velocity (∆Vpeak) were determined over one controlled respiratory cycle before and after fluid loading. Thirteen (41%) participants were fluid-responders. ∆IVC, ∆Vpeak, stroke volume index, and cardiac index were found to be predictors of fluid responsiveness. However, the area under the ROC curve of ∆IVC was smaller when compared to ∆Vpeak (0.709 vs. 0.935, p < 0.012). The best cut-off values were 7.7% for ∆IVC (sensitivity, 69.2%; specificity 78.9%, positive predictive value, 69.2%; and negative predictive value, 78.9%) and 18.2% for ∆Vpeak (sensitivity, 84.6%; specificity, 89.5%; positive predictive value, 84.6%; negative predictive value, 89.5%). Changes in stroke volume were positively correlated with ∆IVC (ρ = 0.566, p < 0.001) and ∆Vpeak (ρ = 0.603, p < 0.001). A significant correlation was also found between changes in MAP and ∆Vpeak (ρ = 0.382; p = 0.031), but the same was not observed with ∆IVC (ρ = 0.011; p = 0.951). In conclusion, ∆IVC was found to have a moderate accuracy in predicting fluid responsiveness in mechanically ventilated children and is an inferior predictor when compared to ∆Vpeak.

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Data Availability

The data that support the findings of this study are available from the corresponding author, upon reasonable request.

Code Availability

Not applicable.

Abbreviations

ΔIVC:

Respiratory variation of inferior vena cava diameters

∆Vpeak:

Respiratory variation in aortic blood flow peak velocity

AUROC:

Area under the ROC curve

Ci:

Cardiac index

Da:

Aortic diameter

IQR:

Interquartile range

IVC:

Inferior vena cava

MAP:

Mean arterial pressure

NPV:

Negative predictive value

PICU:

Pediatric intensive care unit

POCUS:

Point-of-care ultrasound

PPV:

Positive predictive value

ROC curve:

Receiver operating characteristic curve

SV:

Stroke volume

SVi:

Stroke volume index

TTE:

Transthoracic echocardiography

VTI:

Velocity–time integral

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Acknowledgements

Thanks to Carolina Grotta Ramos Telio for her review of the article. We also thank the nursing, technical staff, and the pediatric intensive care residents.

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Authors and Affiliations

  1. Pediatric Intensive Care Unit, Department of Pediatrics, State University of Campinas (UNICAMP), 126, Tessália Vieira de Camargo Street, Campinas, SP, 13083-887, Brazil

    Nathalia Barros Campos, Lícia Bertanha de Lima, Isabel de Siqueira Ferraz, Roberto J. N. Nogueira, Marcelo B. Brandão & Tiago H. de Souza

  2. Department of Pediatrics, School of Medicine, São Leopoldo Mandic, Campinas, SP, Brazil

    Roberto J. N. Nogueira

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  1. Nathalia Barros Campos
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  2. Lícia Bertanha de Lima
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  3. Isabel de Siqueira Ferraz
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  4. Roberto J. N. Nogueira
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  5. Marcelo B. Brandão
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  6. Tiago H. de Souza
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Contributions

NC and LdL: responsible for data collection, drafting and critical revision of the manuscript. IF, RN, and MB: responsible for critical revision of the manuscript for important intellectual content. TdS: responsible for the study concept and design, data collection, analysis and interpretation of data.

Corresponding author

Correspondence to Tiago H. de Souza.

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Conflict of interest

The authors have no conflicts of interest relevant to this study to disclose.

Ethics Approval

The study was approved by the local institutional review board (UNICAMP’s Research and Ethics Committee, approval number 12894719.8.0000.5404).

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Written informed consent was obtained from the participants’ legal guardian.

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Campos, N.B., de Lima, L.B., Ferraz, I.d. et al. Accuracy of Respiratory Variation in Inferior Vena Cava Diameter to Predict Fluid Responsiveness in Children Under Mechanical Ventilation. Pediatr Cardiol (2023). https://doi.org/10.1007/s00246-023-03115-y

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