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Utility of Inferior Vena Cava Distensibility and Respiratory Variation in Peak Aortic Blood Flow Velocity to Predict Fluid Responsiveness in Children with Shock

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Indian Journal of Pediatrics Aims and scope Submit manuscript

Abstract

Objectives

To evaluate the sensitivity and specificity of inferior vena cava (IVC) distensibility index (∆IVC) and respiratory variation in peak aortic blood flow velocity (∆Vpeak) to predict fluid responsiveness in ventilated children with shock and to find out the best cut-off values for predicting fluid responsiveness.

Methods

In this prospective observational study, conducted in a pediatric ICU from January 2019 through May 2020, consecutive children aged 2 mo to 17 y with shock requiring fluid bolus were included. ∆IVC and ∆Vpeak were measured before and immediately after 10 ml/kg fluid bolus administration. ∆IVC and ∆Vpeak were compared between responders and non-responders, defined by a change in stroke volume index (SVI) of ≥10%.

Results

Thirty-seven ventilated children [26 (70.4%) boys] with median age of 60 (36, 108) mo were included. The median (IQR) ∆IVC was 21.7% (14.3, 30.9) and the median (IQR) ΔVpeak was 11.3% (7.2, 15.2). Twenty-three (62%) children were fluid responsive. The median (IQR) ∆IVC was higher in responders compared to non-responders [26% (16.9, 36.5) vs. 17.2% (8.4, 21.9); p = 0.018] and mean (SD) ΔVpeak was higher in responders [13.9% (6.1) vs. 8.4% (3.9), p = 0.004]. The prediction of fluid responsiveness with ΔIVC [ROC curve area 0.73 (0.56–0.9), p = 0.01] and ΔVpeak [ROC curve area 0.78 (0.63–0.94), p = 0.002] was similar. The best cut-off of ∆IVC to predict fluid responsiveness was 23% (sensitivity, 60.8%; specificity, 85.7%) and ΔVpeak was 11.3% (sensitivity, 74%; specificity, 86%).

Conclusions

In this study, authors found that ∆IVC and ΔVpeak were good predictors of fluid responsiveness in ventilated children with shock.

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Acknowledgements

The authors are thankful to PICU senior residents and junior residents for their contribution to the conduct of the study.

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Authors and Affiliations

  1. Department of Pediatrics, 3rd floor, Teaching Block, All India Institute of Medical Sciences, New Delhi, India

    Kiran Kumar Banothu, Jhuma Sankar, Priyanka Gupta, Sushil Kumar Kabra & Rakesh Lodha

  2. Department of Research & Development, Kalinga Institute of Medical Sciences, Bhubaneswar, Odisha, India

    Mona Pathak

  3. Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, India

    Devasenathipathy Kandasamy

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  1. Kiran Kumar Banothu
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  2. Jhuma Sankar
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  3. Mona Pathak
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  4. Devasenathipathy Kandasamy
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  5. Priyanka Gupta
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  6. Sushil Kumar Kabra
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  7. Rakesh Lodha
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Contributions

KKB, JS conceptualized the study, enrolled patients, analyzed the data and drafted the manuscript; DK conceptualized the study, verified all the echocardiographic data and helped with the manuscript; PG helped with patient enrollment, collected data and provided inputs to the manuscript; MP helped with statistical analysis and provided inputs to the manuscript; SKK and RL provided critical inputs to the manuscript and supervised the study. SKK will act as the guarantor for this manuscript.

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Correspondence to Jhuma Sankar.

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Banothu, K.K., Sankar, J., Pathak, M. et al. Utility of Inferior Vena Cava Distensibility and Respiratory Variation in Peak Aortic Blood Flow Velocity to Predict Fluid Responsiveness in Children with Shock. Indian J Pediatr 90, 1077–1082 (2023). https://doi.org/10.1007/s12098-023-04585-x

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  • DOI: https://doi.org/10.1007/s12098-023-04585-x

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