Respiratory changes in inferior vena cava diameter are helpful in predicting fluid responsiveness in ventilated septic patients
Purchase on Springer.com
$39.95 / €34.95 / £29.95*
Rent the article at a discountRent now
* Final gross prices may vary according to local VAT.
To evaluate the extent to which respiratory changes in inferior vena cava (IVC) diameter can be used to predict fluid responsiveness.
Prospective clinical study.
Hospital intensive care unit.
Twenty-three patients with acute circulatory failure related to sepsis and mechanically ventilated because of an acute lung injury.
Inferior vena cava diameter (D) at end-expiration (Dmin) and at end-inspiration (Dmax) was measured by echocardiography using a subcostal approach. The distensibility index of the IVC (dIVC) was calculated as the ratio of Dmax − Dmin / Dmin, and expressed as a percentage. The Doppler technique was applied in the pulmonary artery trunk to determine cardiac index (CI). Measurements were performed at baseline and after a 7 ml/kg volume expansion using a plasma expander. Patients were separated into responders (increase in CI ≥15%) and non-responders (increase in CI <15%).
Using a threshold dIVC of 18%, responders and non-responders were discriminated with 90% sensitivity and 90% specificity. A strong relation (r=0.9) was observed between dIVC at baseline and the CI increase following blood volume expansion. Baseline central venous pressure did not accurately predict fluid responsiveness.
Our study suggests that respiratory change in IVC diameter is an accurate predictor of fluid responsiveness in septic patients.
- Weil MH, Nishjima (1978) Cardiac output in bacterial shock. Am J Med 64:920–922
- Murakawa K, Kobayashi A (1988) Effect of vasopressors on renal tissue gas tensions during hemorrhagic shocks in dogs. Crit Care Med 16:789–792
- Magder S (1992) Shock physiology. In: Pinsky MR, Dhainault JF (eds) Physiological foundation of critical care medicine. Williams and Wilkins, Philadelphia, pp 140–160
- Guyton AC, Jones CE, Coleman TG (1973) Circulatory physiology: cardiac output and its regulation. Saunders, Philadelphia
- Michard F, Teboul JL (2002) Predicting fluid responsiveness in ICU patients. A critical analysis of the evidence. Chest 121:2000–2008
- Michard F, Boussat S, Chemla D, Anguel N, Mercat A, Lecarpentier Y, Richard C, Pinsky MR, Teboul JL (2000) Relation between respiratory changes in arterial pulse pressure and fluid responsiveness in septic patients with acute circulatory failure . Am J Respir Crit Care Med 162:134–138
- Comolet R (1984) Biomécanique Circulatoire. Abrégé Masson, pp 36–53
- American College of Chest Physicians/Society of Critical Care Medicine Consensus conference (1992) Definitions for sepsis and organ failure and guidelines for use of innovative therapies in sepsis (review). Crit Care Med 27:864–874
- Fusco MA, Shayn Martin R, Chang MC (2001) Estimation of intra-abdominal pressure by bladder pressure measurement: validity and methodology. J Trauma 50:297–302
- Maslow A, Comunale ME, Haering JM, Watkins J (1996) Pulsed wave Doppler measurement of cardiac output from the right ventricular outflow tract. Anesth Analg 83:466–471
- Calvin JE, Driedger AA, Sibbald WJ (1981) The hemodynamic effect of rapid fluid infusion in critically ill patients. Surgery 90:61–76
- Reuse C, Vincent JL, Pinsky MR (1990) Measurements of right ventricular volumes during fluid challenge. Chest 98:1450–1454
- Natori H, Tamaki S, Kira S (1979) Ultrasonographic evaluation of ventilatory effect on inferior vena caval configuration. Am Rev Respir Dis 120:421–427
- Jeffrey RB, Federle MP (1988) The collapsed inferior vena cava: CT evidence of hypovolemia. Am J Roentgen 150:431–432
- Nakao S, Come P, Mckay RG, Ransil BJ (1987) Effect of positional changes on inferior vena caval size and dynamics and correlation with right-sided cardiac pressure. Am J Cardiol 59:125–132
- Takata M, Wise RA, Robotham JL (1990) Effect of abdominal pressure on venous return: abdominal vascular zone conditions. J Appl Physiol 69:1961–1972
- Jardin F, Dubourg O, Margairaz A, Bourdarias JP (1987) Inspiratory impairment in right ventricular performance during acute asthma. Chest 92:789–795
- Kircher BJ, Himelman RB, Schiller NB (1990) Noninvasive estimation of right atrial pressure from the inspiratory collapse of the inferior vena cava. Am J Cardiol 66:493–496
- Nagueh SF, Kopelen HA, Zoghbi WA (1996) Relation of mean right atrial pressure to echocardiographic and Doppler parameters of the right atrial and right ventricular function. Circulation 93:1160–1169
- Jue J, Chung W, Schiller NB (1992) Does inferior vena cava size predict right atrial pressures in patients receiving mechanical ventilation? J Am Soc Echocardiogr 5:613–619
- Mitaka C, Nagura T, Sakanishi N, Tsunoda Y, Amaha K (1989) Two-dimensional echographic evaluation of inferior vena cava, right and left ventricle during positive-pressure ventilation with varying level of positive end-expiratory pressure. Crit Care Med 17:205–210
- Van Den Berg PC, Jansen JRC, Pinsky MR (2002) Effect of positive pressure on venous return in volume-loaded surgical patients. J Appl Physiol 92:1223–1231
- Antunes T, Anbar J, Barbas C (2003) Effects of PEEP and external abdominal weight on respiratory mechanics. Intensive Care Med 28:S34
- Jardin F, Genevray B, Brun-Ney D, Bourdarias JP (1985) Influence of lung and chest wall compliance on transmission of airway pressure to the pleural space in critically ill patients. Chest 88:653–658
- Vieillard-Baron A, Augarde R, Prin S, Page B, Beauchet A, Jardin F (2001) Influence of superior vena caval zone condition on cyclic changes in right ventricular outflow during respiratory support. Anesthesiology 95:1083–1088
- Feissel M, Michard F, Mangin I, Ruyer O, Faller JP, Teboul JL (2001) Respiratory changes in aortic blood velocity as an indicator of fluid responsiveness in ventilated patients with septic shock. Chest 119:867–873
- Respiratory changes in inferior vena cava diameter are helpful in predicting fluid responsiveness in ventilated septic patients
Intensive Care Medicine
Volume 30, Issue 9 , pp 1740-1746
- Cover Date
- Print ISSN
- Online ISSN
- Additional Links
- Inferior vena cava
- Central venous pressure
- Fluid responsiveness
- Mechanical ventilation
- Industry Sectors
- Author Affiliations
- 1. Medical and Surgical Intensive Care Unit, Hospital St. Germain-en-Laye, 20 rue Armagis, 78100, St Germain-en-Laye, France
- 2. Medical Intensive Care Unit, University Hospital Ambroise Paré, Assistance Publique Hôpitaux de Paris, 9 avenue Charles de Gaulle, 92104, Boulogne Cedex, France