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Alternative echographic assessment of inferior vena cava diameter variation in mechanically ventilated patients

Introduction

The echographic assessment of inferior vena cava (IVC) diameter (IVCD) variation allows for fluid-responsiveness prediction in ventilated septic patients [1, 2]. Its applicability in surgical patients is not established, partly due to the difficulty to acquire a subxiphoidian (SX) view after abdominal surgery. The transhepatic (TH) view of the IVC could provide an interesting alternative.

Methods

In this prospective, randomized, crossover, pilot study, IVCD variation was assessed in consecutive mechanically ventilated (volume control) ICU patients, with SX and TH views, in random order by one operator. M-mode images were acquired at 100 mm/s, 2 cm below the junction of the IVC with the right atrium. The minimal (Dmin) and maximal (Dmax) ICVD values were later measured on pooled images. IVCD variation [2], defined as dIVC = (Dmax - Dmin)/((Dmax + Dmin)/2), was compared between both views (when available): dIVCsx and dIVCth for subxiphoidian and transhepatic views, respectively.

Results

Twenty-eight patients were included, 19 medical and nine surgical. The TH view was obtained in all patients, the SX view in only 22 of them with failures in four surgical and two morbidly obese medical patients. Linear regression showed a strong correlation between dIVCth and dIVCsx (n = 22, r2 = 0.98, P < 0.001). The agreement was satisfactory using Bland–Altman analysis (Figure 1): bias was 0.26%, limits of agreement were -8.4 to +7.9%. Results were similar for the IVC distensibility index [1].

Figure 1
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abstract P215

Conclusion

Our results suggest that the SX view, when unavailable, can be replaced by the TH view for the echographic assessment of IVCD variation. Further study is ongoing to formally establish its validity as a predictor of fluid responsiveness, especially in surgical ICU patients.

References

  1. 1.

    Barbier C, et al.: Intensive Care Med. 2004, 30: 1740-1746.

  2. 2.

    Feissel M, et al.: Intensive Care Med. 2004, 30: 1834-1837. 10.1007/s00134-004-2233-5

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Leclerc, T., Libert, N., Tourtier, J. et al. Alternative echographic assessment of inferior vena cava diameter variation in mechanically ventilated patients. Crit Care 13, P215 (2009). https://doi.org/10.1186/cc7379

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Keywords

  • Inferior Vena Cava
  • Random Order
  • Surgical Patient
  • Volume Control
  • Inferior Vena