The place of inferior vena cava diameter and proBNP levels in determining the fluid balance of medical intensive care patients
Objective: Fast and accurate detection of fluid balance in intensive care patients is of special significance. Many different methods are used to determine the fluid balance. In this study, we aimed to determine the fluid balance of patients in the medical intensive care unit using measurement of the inferior vena cava diameter and pro-brain natriuretic peptide (proBNP). Patients and Methods: Patients admitted to the medical intensive care unit between September 2013 and February 2014 were enrolled in the study. Inferior vena cava diameter was measured with a portable ultrasonography, according to guidelines published by the American Echocardiography Association. For pro BNP measurement, samples were taken simultaneously with ultrasonography. Results: One hundred and twenty-six patients (70 male,55.6%) were enrolled for the study. Mean age was 57.8 ± 19.8 (18-89 years). Nintey six (76.2%) patients were receiving mechanical ventilation support. Mean proBNP levels were 10645.88 ± 12731.08 pg/ml. There was no statistically significant difference between proBNP levels in patients according to the fluid status. Collapsibility index was not statistically different according to the volume status (p=0.75). Conclusion: proBNP levels were not correlated with the fluid balance. proBNP levels and inferior vena cava diameters were negatively but weakly correlated.
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- De Backer D, Vincent JL. The pulmonary artery catheter: is it
still alive? Curr Opin Crit Care 2018;24:204-8. doi: 10.1097/
mcc.000.000.0000000502
- Singer M, Deutschman CS, Seymour CW, et al. The Third
International Consensus Definitions for Sepsis and Septic
Shock (Sepsis-3). JAMA 2016;315:801-10. doi: 10.1001/
jama.2016.0287
- Theerawit P, Morasert T, Sutherasan Y. Inferior vena cava
diameter variation compared with pulse pressure variation as
predictors of fluid responsiveness in patients with sepsis. J Crit
Care 2016;36:246-51. doi: 10.1016/j.jcrc.2016.07.023
- Steinwandel U, Gibson N, Towell A, Rippey JJR, Rosman
J. Can a renal nurse assess fluid status using ultrasound on
the inferior vena cava? A cross-sectional interrater study.
International Symposium on Home Hemodialysis. Hemodial
Int 2018;22:261-9. doi:10.1111/hdi.12606
- Alexiadis G, Panagoutsos S, Roumeliotis S, et al. Comparison
of multiple fluid status assessment methods in patients on
chronic hemodialysis. Int Urol Nephrol 2017;49:525-32.
10.1007/s11255.016.1473-y
- McLean AS, Huang SJ. The applications of B-type
natriuretic peptide measurement in the intensive care
unit. Curr Opin Crit Care 2005;11:406-12. doi:10.1097/01.
ccx.000.017.6695.92883.87
- Rudski LG, Lai WW, Afilalo J, et al. Guidelines for the
echocardiographic assessment of the right heart in adults:
a report from the American Society of Echocardiography.
Endorsed by the European Association of Echocardiography,
a registered branch of the European Society of Cardiology,
and the Canadian Society of Echocardiography. JAm
Soc Echocardiogr 2010;23:685-713. doi:10.1016/j.
echo.2010.05.010
- Thanakitcharu P, Charoenwut M, Siriwiwatanakul N. Inferior
vena cava diameter and collapsibility index: a practical noninvasive
evaluation of intravascular fluid volume in criticallyill
patients. JMedAssocThailand = Chotmaihet thangphaet
2013;96 Suppl 3:S14-22.
- Wang WJ, Zhang XM, Wang Q, et al. [Amino-terminal
pro-brain natriuretic peptide and brain natriuretic peptide
measurements under various detection conditions in patients
with chronic heart failure]. Zhonghua Xin Xue Guan Bing Za
Zhi 2011;39:695-9.
- Lee SW, Song JH, Kim GA, Lim HJ, Kim MJ. Plasma brain
natriuretic peptide concentration on assessment of hydration
status in hemodialysis patient. Am J Kidney Dis 2003;41:1257-
66. doi: 10.1016/s0272-6386(03)00358-5
- Crepaldi C, Lamas EI, Martino FK, et al. Bioimpedance
and brain natriuretic peptide in peritoneal dialysis patients.
Contrib Nephrol 2012;178:174-81. doi: 10.1159/000337849
- Tapolyai M, Faludi M, Réti V, et al. Volume estimation in
dialysis patients: the concordance of brain-type natriuretic
peptide measurements and bioimpedance values.
International Symposium on Home Hemodialysis. Hemodial
Int 2013;17:406-12. doi: 10.1111/hdi.12023
- Ferrada P, Anand RJ, Whelan J, et al. Qualitative assessment
of the inferior vena cava: useful tool for the evaluation of fluid
status in critically ill patients. Am Surg 2012;78:468-70.
- Zhang Z, Xu X, Ye S, Xu L. Ultrasonographic measurement
of the respiratory variation in the inferior vena cava diameter
is predictive of fluid responsiveness in critically ill patients:
systematic review and meta-analysis. Ultrasound Med Biol
2014;40:845-53. doi:10.1016/j.ultrasmedbio.2013.12.010
- Dipti A, Soucy Z, Surana A, Chandra S. Role of inferior vena
cava diameter in assessment of volume status: a meta-analysis.
Am JEmerg Med 2012;30(8):1414-9.e1. doi: 10.1016/j.
ajem.2011.10.017
- Orso D, Paoli I, Piani T, Cilenti FL, Cristiani L, Guglielmo
N. Accuracy of ultrasonographic measurements of inferior
vena cava to determine fluid responsiveness: A systematic
review and meta-analysis. JInt Care Med 2020;35:354-63. doi:
10.1177/088.506.6617752308
- Long E, Oakley E, Duke T, Babl FE. Does respiratory variation
in inferior vena cava diameter predict fluid responsiveness:
A systematic review and meta-analysis. Shock2017;47:550-9.
doi:10.1097/shk.000.000.0000000801
- Zhang X, Luan H, Zhu P, Feng J, Cui J, Zhao Z. Does
ultrasonographic measurement of the inferior vena cava
diameter correlate with central venous pressure in the
assessment of intravascular volume in patients undergoing
gastrointestinal surgery? Journal Surg Res2014;191:339-43.
doi: 10.1016/j.jss.2014.04.043
- Muller L, Bobbia X, Toumi M, et al. Respiratory variations of
inferior vena cava diameter to predict fluid responsiveness
in spontaneously breathing patients with acute circulatory
failure: need for a cautious use. Crit Care 2012;16:R188.
doi:10.1186/cc11672
- Hebl V, Zakharova MY, Canoniero M, Duprez D, Garcia S.
Correlation of natriuretic peptides and inferior vena cava size
in patients with congestive heart failure. Vasc Health Risk
Manag 2012;8:213-8. doi: 10.2147/vhrm.s30001
- Goonewardena SN, Gemignani A, Ronan A, et al. Comparison
of hand-carried ultrasound assessment of the inferior vena cava
and N-terminal pro-brain natriuretic peptide for predicting
readmission after hospitalization for acute decompensated
heart failure. JACC Cardiovasc Imaging 2008;1:595-601. doi:
10.1016/j.jcmg.2008.06.005
- Yavaşi Ö, Ünlüer EE, Kayayurt K, et al. Monitoring the
response to treatment of acute heart failure patients by
ultrasonographic inferior vena cava collapsibility index. Am
J Emerg Med 2014;32:403-7. doi: 10.1016/j.ajem.2013.12.046