Titre :

Measurement site of inferior vena cava diameter affects the accuracy with which fluid responsiveness can be predicted in spontaneously breathing patients: a post hoc analysis of two prospective cohorts

Auteur(s) :

Caplan, Morgan [Auteur]
Université de Lille
Centre Hospitalier Régional Universitaire [CHU Lille] [CHRU Lille]
Durand, Arthur [Auteur]
Université de Lille
Centre Hospitalier Régional Universitaire [CHU Lille] [CHRU Lille]
Bortolotti, Perrine [Auteur]
Université de Lille
Centre Hospitalier Régional Universitaire [CHU Lille] [CHRU Lille]
Colling, Delphine [Auteur]
Université de Lille
Centre Hospitalier Régional Universitaire [CHU Lille] [CHRU Lille]
GOUTAY, Julien [Auteur]
Université de Lille
Centre Hospitalier Régional Universitaire [CHU Lille] [CHRU Lille]
Duburcq, Thibault [Auteur]
Université de Lille
Centre Hospitalier Régional Universitaire [CHU Lille] [CHRU Lille]
Drumez, Elodie [Auteur]
Evaluation des technologies de santé et des pratiques médicales - ULR 2694 [METRICS]
Rouze, Anahita [Auteur]
Université de Lille
Centre Hospitalier Régional Universitaire [CHU Lille] [CHRU Lille]
Nseir, Saad [Auteur]
Université de Lille
Centre Hospitalier Régional Universitaire [CHU Lille] [CHRU Lille]
Howsam, Michael [Auteur]
Facteurs de Risque et Déterminants Moléculaires des Maladies liées au Vieillissement - U 1167 [RID-AGE]
Onimus, Thierry [Auteur]
Université de Lille
Centre Hospitalier Régional Universitaire [CHU Lille] [CHRU Lille]
Favory, Raphael [Auteur]
Facteurs de Risque et Déterminants Moléculaires des Maladies liées au Vieillissement - U 1167 [RID-AGE]
Preau, Sebastien [Auteur correspondant]
Facteurs de Risque et Déterminants Moléculaires des Maladies liées au Vieillissement - U 1167 [RID-AGE]

Titre de la revue :

Annals of Intensive Care

Pagination :

168

Éditeur :

SpringerOpen

Date de publication :

2020

ISSN :

2110-5820

Mot(s)-clé(s) en anglais :

Inferior vena cava
Fluids
Fluid responsiveness
Hemodynamic
Sepsis
Severe infection
Ultrasound
Echocardiography
Collapsibility index
Spontaneous breathing

Discipline(s) HAL :

Sciences du Vivant [q-bio]/Médecine humaine et pathologie/Cardiologie et système cardiovasculaire
Sciences du Vivant [q-bio]/Ingénierie biomédicale/Imagerie

Résumé en anglais : [en]

Background: The collapsibility index of the inferior vena cava (cIVC) has potential for predicting fluid responsiveness in spontaneously breathing patients, but a standardized approach for measuring the inferior vena cava ...
Lire la suite >Background: The collapsibility index of the inferior vena cava (cIVC) has potential for predicting fluid responsiveness in spontaneously breathing patients, but a standardized approach for measuring the inferior vena cava diameter has yet to be established.The aim was to test the accuracy of different measurement sites of inferior vena cava diameter to predict fluid responsiveness in spontaneously breathing patients with sepsis-related circulatory failure and examine the influence of a standardized breathing manoeuvre.Results: Among the 81 patients included in the study, the median Simplified Acute Physiologic Score II was 34 (24; 42). Sepsis was of pulmonary origin in 49 patients (60%). Median volume expansion during the 24 h prior to study inclusion was 1000 mL (0; 2000). Patients were not severely ill: none were intubated, only 20% were on vasopressors, and all were apparently able to perform a standardized breathing exercise. Forty-one (51%) patients were responders to volume expansion (i.e. a ≥ 10% stroke volume index increase). The cIVC was calculated during non-standardized (cIVC-ns) and standardized breathing (cIVC-st) conditions. The accuracy with which both cIVC-ns and cIVC-st predicted fluid responsiveness differed significantly by measurement site (interaction p < 0.001 and < 0.0001, respectively). Measuring inferior vena cava diameters 4 cm caudal to the right atrium predicted fluid responsiveness with the best accuracy. At this site, a standardized breathing manoeuvre also significantly improved predictive power: areas under ROC curves [mean and (95% CI)] for cIVC-ns = 0.85 [0.78–0.94] versus cIVC-st = 0.98 [0.97–1.0], p < 0.001. When cIVC-ns is superior or equal to 33%, fluid responsiveness is predicted with a sensitivity of 66% and a specificity of 92%. When cIVC-st is superior or equal to 44%, fluid responsiveness is predicted with a sensitivity of 93% and a specificity of 98%.Conclusion: The accuracy with which cIVC measurements predict fluid responsiveness in spontaneously breathing patients depends on both the measurement site of inferior vena cava diameters and the breathing regime. Measuring inferior vena cava diameters during a standardized inhalation manoeuvre at 4 cm caudal to the right atrium seems to be the method by which to obtain cIVC measurements best-able to predict patients’ response to volume expansion.Lire moins >

Langue :

Anglais

Comité de lecture :

Oui

Audience :

Internationale

Vulgarisation :

Non

Collections :

• Facteurs de risque et déterminants moléculaires des maladies liées au vieillissement (RID-AGE) - U1167

Source :

Harvested from HAL