Respiratory changes of the inferior vena cava diameter predict fluid responsiveness in spontaneously breathing patients with cardiac arrhythmias

Background Whether the respiratory changes of the inferior vena cava diameter during a deep standardized inspiration can reliably predict fluid responsiveness in spontaneously breathing patients with cardiac arrhythmia is unknown. Methods This prospective two-center study included nonventilated arrh...

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Published in:Annals of intensive care 2018-08, Vol.8 (1), p.79-12, Article 79
Main Authors: Bortolotti, Perrine, Colling, Delphine, Colas, Vincent, Voisin, Benoit, Dewavrin, Florent, Poissy, Julien, Girardie, Patrick, Kyheng, Maeva, Saulnier, Fabienne, Favory, Raphael, Preau, Sebastien
Format: Article
Language:English
Subjects:
Anesthesiology
Arrhythmia
Atrial fibrillation
Cardiac arrhythmia
Cardiology and cardiovascular system
Catheters
Critical Care Medicine
Emergency Medicine
Fluid responsiveness
Hemodynamic
Hemodynamics
Human health and pathology
Infectious diseases
Inferior vena cava
Intensive
Intensive care
Life Sciences
Medicine
Medicine & Public Health
Sepsis
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Summary:Background Whether the respiratory changes of the inferior vena cava diameter during a deep standardized inspiration can reliably predict fluid responsiveness in spontaneously breathing patients with cardiac arrhythmia is unknown. Methods This prospective two-center study included nonventilated arrhythmic patients with infection-induced acute circulatory failure. Hemodynamic status was assessed at baseline and after a volume expansion of 500 mL 4% gelatin. The inferior vena cava diameters were measured with transthoracic echocardiography using the bi-dimensional mode on a subcostal long-axis view. Standardized respiratory cycles consisted of a deep inspiration with concomitant control of buccal pressures and passive exhalation. The collapsibility index of the inferior vena cava was calculated as [(expiratory–inspiratory)/expiratory] diameters. Results Among the 55 patients included in the study, 29 (53%) were responders to volume expansion. The areas under the ROC curve for the collapsibility index and inspiratory diameter of the inferior vena cava were both of 0.93 [95% CI 0.86; 1]. A collapsibility index ≥ 39% predicted fluid responsiveness with a sensitivity of 93% and a specificity of 88%. An inspiratory diameter 
ISSN:2110-5820
2110-5820
DOI:10.1186/s13613-018-0427-1