Inferior Vena Cava Distensibility as a Predictor of Fluid Responsiveness in Patients with Subarachnoid Hemorrhage
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The objective of our study is to assess the reliability of the distensibility of the inferior vena cava (dIVC), as measured by ultrasound, as an indicator of fluid responsiveness in patients with subarachnoid hemorrhage.
We enrolled 29 adult patients requiring advanced hemodynamic monitoring, sedation, and mechanical ventilation. Inferior vena cava diameter was measured during a single mechanical breath. The dIVC was calculated as (the diameter of the inferior vena cava on inspiration—the diameter on expiration)/the diameter on expiration. All the hemodynamic parameters were collected at baseline and after a fluid challenge (7 ml/kg) with 6% hydroxyethyl starch. A 15% increase of cardiac index was the standard criterion used to differentiate patients with and without a response to fluid therapy.
Apart from stroke volume variation (SVV) and dIVC, which were significantly higher in fluid responders (17 patients), the other baseline characteristics did not differ significantly between groups (responders versus non-responders). Significant changes in hemodynamic parameters after volume load were observed only in fluid responders. The area under the ROC curve was 0.779 (95% confidence interval 0.587–0.911) for SVV and 0.902 (95% confidence interval 0.733–0.979, P = NS) for dIVC. Central venous pressure was a less reliable indicator of fluid responsiveness than dIVC. A dIVC value of >16% yielded the most favorable balance of test characteristics, with 70.59% sensitivity and 100% specificity. There was a trend toward a lower incidence of delayed ischemic lesions in fluid responders (11.7 vs. 25%, P = NS).
dIVC proved to be a reliable predictor of fluid responsiveness in ICU patients with subarachnoid hemorrhage.
KeywordsInferior vena cava ultrasonography Fluid responsiveness Preload indicators
- 3.Magder S. Shock physiology. In: Pinsky MR, Dhainault JF, editors. Physiological foundation of critical care medicine. Philadelphia: Williams and Wilkins; 1992. p. 140–60.Google Scholar
- 4.Guyton AC. Cardiac output and circulatory shock. In: Guyton AC, editor. Human physiology and mechanisms of disease. 5th ed. Philadelphia: Saunders; 1991. p. 187–200.Google Scholar
- 14.Hofer CK, Furrer L, Matter-Esner S, Maloigne M, Klaghofer R, Genoni M. Volumetric preload measurement by thermodilution: a comparison with transesophageal echocardiography. Br J Anesth. 2005;94:749–55.Google Scholar
- 15.Della Rocca G, Costa MG. Preload index and fluid responsiveness: different aspects of the new concept of functional hemodynamic monitoring. Minerva Anesth. 2008;74:349–51.Google Scholar
- 19.Kusaba T, Yamaguchi K, Oda H. Echography of the inferior vena cava for estimating fluid removal from patients undergoing hemodialysis. Jpn J Nephrol. 1994;36(8):914–20.Google Scholar