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.
This is a preview of subscription content, log in via an institution to check access.
References
Costanzo MR, Guglin ME, Saltzberg MT, Jessup ML, Bart BA, Teerlink JR, Jaski BE, Fang JC, Feller ED, Haas GJ, Anderson AS, Schollmeyer MP, Sobotka PA, UNLOAD Trial Investigators (2007) Ultrafiltration versus intravenous diuretics for patients hospitalized for acute decompensated heart failure. J Am Coll Cardiol 49:675–683
Ronco C, Ricci Z, Bellomo R, Bedogni F (2001) Extracorporeal ultrafiltration for the treatment of overhydration and congestive heart failure. Cardiology 96:155–168
Vieillard-Baron A, Slama M, Cholley B, Janvier G, Vignon P (2008) Echocardiography in the intensive care unit: from evolution to revolution? Intensive Care Med 34:243–249
Feissel M, Michard F, Faller JP, Teboul JL (2004) The respiratory variation in inferior vena cava diameter as a guide to fluid therapy. Intensive Care Med 30:1834–1837
Barbier C, Jardin F, Vieillard-Baron A (2004) Respiratory changes in inferior vena cava diameter are helpful in predicting fluid responsiveness in ventilated septic patients. Intensive Care Med 30:1740–1746
Schumacher J, Robb P, Kreftb B, Engelke A, Heringlake M, Klotz KF (2000) Measurement of fluid volume shifts during hemodialysis by A-mode ultrasonography. Blood Purif 18:103–109
Ishibe S, Peixoto AJ (2004) Methods of assessment of volume status and intercompartmental fluid shifts in hemodialysis patients: implications in clinical practice. Semin Dial 17:37–43
Yashiro M, Kamata T, Yamadori N, Tomita M, Muso E (2007) Evaluation of markers to estimate volume status in hemodialysis patients: atrial natriuretic peptide, inferior vena cava diameter, blood volume changes and filtration coefficients of microvasculature. Ther Apher Dial 11:131–137
Van De Pol ACM, Frenken LA, Moret K, Van Der Sande FM, Beerenhout CM, Kooman JP, Leunissen KM (2007) An evaluation of blood volume changes during ultrafiltration pulses and natriuretic peptides in the assessment of dry weight in hemodialysis patients. Hemodial Int 11:51–61
Mintz G, Kotler M, Parry W, Iskandrian A, Kane S (1981) Real-time inferior vena caval ultrasonography: normal and abnormal findings and its use in assessing right heart function. Circulation 64:1018–1025
Moreno F, Hagan A, Holmen J, Pryor A, Strickland R, Castle H (1984) Evaluation of size and dynamics of the inferior vena cava as an index of right-sided cardiac function. Am J Cardiol 52:579–585
Jardin F, Vieillard-Baron A (2006) Ultrasonographic examination of the venae cavae. Intensive Care Med 32:203–206
Blehar DJ, Dickman E, Gaspari R (2009) Identification of congestive heart failure via respiratory variation of inferior vena cava diameter. Am J Emerg Med 27:71–75
Costanzo MR (2008) Ultrafiltration in the management of heart failure. Curr Opin Crit Care 14:524–530
Marenzi GC, Lauri G, Grazi M, Assanelli E, Campodonico J, Agostoni PG (2001) Circulatory response to fluid overload removal by extracorporeal ultrafiltration in refractory congestive heart failure. J Am Coll Cardiol 38:963–968
Costanzo MR, Saltzberg M, O’Sullivan J, Sobotka P (2005) Early ultrafiltration in patients with decompensated heart failure and diuretic resistance. J Am Coll Cardiol 46:2047–2051
Bart BA, Boyle A, Bank AJ, Anand I, Olivari MT (2005) Ultrafiltration versus usual care for hospitalized patients with heart failure: the relief for acutely fluid-overloaded patients with decompensated congestive heart failure (RAPID-CHF) trial. J Am Coll Cardiol 46:2043–2046
Pinsky MR, Payen D (2005) Functional hemodynamic monitoring. Critical Care 9:566–572
Author information
Authors and Affiliations
Corresponding author
Electronic supplementary material
Below is the link to the electronic supplementary material.
134_2009_1745_MOESM4_ESM.tif
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)
Rights and permissions
About this article
Cite this article
Guiotto, G., Masarone, M., Paladino, F. et al. Inferior vena cava collapsibility to guide fluid removal in slow continuous ultrafiltration: a pilot study. Intensive Care Med 36, 692–696 (2010). https://doi.org/10.1007/s00134-009-1745-4
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00134-009-1745-4