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Intensive Care Medicine

, Volume 36, Issue 4, pp 692–696 | Cite as

Inferior vena cava collapsibility to guide fluid removal in slow continuous ultrafiltration: a pilot study

  • Giovanna GuiottoEmail author
  • Mario Masarone
  • Fiorella Paladino
  • Enrico Ruggiero
  • Sean Scott
  • Sossio Verde
  • Fernando Schiraldi
Brief Report

Abstract

Objective

To investigate whether ultrasound determination of the inferior vena cava diameter (IVCD) and its collapsibility index (IVCCI) could be used to optimize the fluid removal rate while avoiding hypotension during slow continuous ultrafiltration (SCUF).

Methods

Twenty-four consecutive patients [13 men and 11 women, mean age 72 ± 5 years; New York Heart Association (NYHA) functional classes III–IV] with acute decompensated heart failure (ADHF) and diuretic resistance were admitted to our 16-bed medical ICU. Blood pressure (BP), heart rate (HR), respiratory rate (RR), blood samples for hematocrit, creatinine, sodium, potassium, and arterial BGA plus lactate were obtained at baseline and than every 2 h from the beginning of SCUF. IVCD, assessed by M-mode subcostal echocardiography during spontaneous breathing, was evaluated before SCUF, at 12 h, and just after the cessation of the procedure. The IVCCI was calculated as follows: [(IVCDmax − IVCDmin)/IVCDmax] × 100.

Results

Mean UF time was 20.3 ± 4.6 h with a mean volume of 287.6 ± 96.2 ml h−1 and a total ultrafiltrate production of 5,780.8 ± 1,994.6 ml. No significant difference in MAP, HR, RR, and IVCD before and after UF was found. IVCCI increased significantly after UF (P < 0.001). Hypotension was observed only in those patients (2/24) who reached an IVCCI >30%. In all the other patients, a significant increase in IVCCI was obtained without any hemodynamic instability.

Conclusion

IVC ultrasound is a rapid, simple, and non-invasive means for bedside monitoring of intravascular volume during SCUF and may guide fluid removal velocity.

Keywords

Heart failure Ultrafiltration Ultrasound Monitoring Inferior vena cava Hypotension 

Supplementary material

134_2009_1745_MOESM1_ESM.tif (3.7 mb)
Correlation between IVCCI and MAP at time zero
134_2009_1745_MOESM2_ESM.tif (3.6 mb)
Correlation between IVCCI and MAP at 12 h
134_2009_1745_MOESM3_ESM.tif (3.6 mb)
Correlation between IVCCI and MAP post SCUF
134_2009_1745_MOESM4_ESM.tif (80 kb)
ROC curves for IVCCI (solid line) and IVC diameter (dotted line) as predictors for hypotension during SCUF. IVCCI vs. MAP <70: Area = 0.976 (CI = 0.918–1.034, SE = 0.030; p = 0.009). IVC diameter vs. MAP <70: Area = 0.870 (CI = 0.732–1.007; SE = 0.070; p = 0.219)

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Copyright information

© Copyright jointly hold by Springer and ESICM 2010

Authors and Affiliations

  • Giovanna Guiotto
    • 1
    Email author
  • Mario Masarone
    • 1
  • Fiorella Paladino
    • 1
  • Enrico Ruggiero
    • 1
  • Sean Scott
    • 1
  • Sossio Verde
    • 1
  • Fernando Schiraldi
    • 1
  1. 1.Medical High Dependency UnitSan Paolo HospitalNaplesItaly

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