1. The Value of the Inferior Vena Cava Area Distensibility Index and its Diameter Ratio for Predicting Fluid Responsiveness in Mechanically Ventilated Patients
- Author
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Bo Yao, Yun-bo Sun, Yu-Xiao Zhao, Lian-di Li, and Jian-yu Liu
- Subjects
Male ,medicine.medical_specialty ,Cardiac output ,Resuscitation ,Fluid responsiveness ,Vena Cava, Inferior ,030204 cardiovascular system & hematology ,Critical Care and Intensive Care Medicine ,Inferior vena cava ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,law ,Internal medicine ,medicine ,Humans ,Prospective Studies ,Cardiac Output ,Prospective cohort study ,Aged ,Ultrasonography ,Receiver operating characteristic ,business.industry ,Ultrasound ,030208 emergency & critical care medicine ,Middle Aged ,Respiration, Artificial ,Intensive care unit ,Intensive Care Units ,ROC Curve ,medicine.vein ,cardiovascular system ,Emergency Medicine ,Cardiology ,Fluid Therapy ,Female ,business - Abstract
Introduction It is necessary to evaluate fluid responsiveness before fluid resuscitation. We evaluated the value of inferior vena cava (IVC) area respiratory variation and the IVC diameter ratio (IVC DR) for predicting fluid responsiveness in mechanically ventilated patients. Methods A prospective observational study was performed in the intensive care unit between December 2017 and March 2018. Mechanically ventilated patients were enrolled and received ultrasound monitoring. IVC diameter distensibility index from the subxiphoid area (IVC-sx DDI), IVC diameter distensibility index from the right midaxillary line (IVC-rm DDI), IVC area distensibility index (IVC ADI), and IVC DR in cross-section were calculated by ultrasound monitoring IVC parameters. The enrolled patients were classified as nonresponders group and responders group according to whether the cardiac output increased by >10% after passive leg raising. Results Data from 67 mechanically ventilated patients were analyzed. 55.2% of patients had positive fluid responsiveness. The area of receiver operating characteristic curves evaluating the ability of the IVC-sx DDI, IVC-rm DDI, IVC ADI, and IVC DR to predict the fluid responsiveness were 0.702, 0.686, 0.749, and 0.829, respectively. IVC DR level of 1.43 was predictive of positive fluid responsiveness with 90.0% specificity and 67.6% sensitivity. IVC ADI level of 10.2% was predictive of positive fluid responsiveness with 40.0% specificity and 97.3% sensitivity. Conclusions IVC ADI and its diameter ratio in cross-section had more value than IVC diameter distensibility index for predicting fluid responsiveness in mechanically ventilated patients.
- Published
- 2019
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