Nimet ŞENOĞLU, Işıl KÖSE, Aykut SARITAŞ, Çiler ZİNCİRCİOĞLU, Uğur UZUN, Pelin UZUN SARITAŞ

Comparison of inferior vena cava collapsibility, distensibility, and delta indices at different positive pressure supports and prediction values of indices for intravascular volume status

Background/aim: To compare the inferior vena cava (IVC) indices, identify their variation rates at positive pressure values and accuratepredictive values for the volume status in patients with spontaneous respiration receiving different positive pressure support.Material and methods: The study included 100 patients who were divided into 4 pressure support groups, according to the differentpressure supports received, and 3 volume groups according to their CVP values. Ultrasonography was applied to all of the patients todefine their IVC diameters at different pressure supports. Dynamic parameters were derived from the ultrasonographic assessment ofthe IVC diameter [collapsibility (CI-IVC), distensibility (dIVC), and delta (ΔIVC) indices].Results: There were significant differences between the 3 indices (CI-IVC, dIVC, and ΔIVC) according to the pressure groups [(10/5),(10/0), (0/5), (t tube 0/0)]. The median value for the dIVC percentages was ≤18% for all of the positive pressure support hypervolemicgroups, apart from the hypervolemic t tube group (19%). For the hypervolemic groups, the best estimation according to the cut-off valueappeared to be for the dIVC. Values with the highest sensitivity for differentiation of the hypovolemic individuals were calculated withthe dIVC.Conclusion: The dIVC had a more accurate predictive role in predicting the volume status when compared with the CI-IVC and ΔIVC,and may be used reliably with positive pressure supports.

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1. Sobczyk D, Nycz K, Andruszkiewicz P, Wierzbicki K, Stapor M. Ultrasonographic caval indices do not significantly contribute to predicting fluid responsiveness immediately after coronary artery bypass grafting when compared to passive leg raising. Cardiovascular Ultrasound 2016; 14 (1): 2-8. doi: 10.1186/ s12947-016-0065-4
2. Orso D, Paoli I, Piani T, Cilenti FL, Cristiani L et al. Accuracy of ultrasonographic measurements of inferior vena cava to determine fluid responsiveness: a systematic review and meta-analysis. Journal of Intensive Care Medicine 2018; 1(885066617752308): 1-10. doi: 10.1177/0885066617752308
3. Blehar DJ, Resop D, Chin B, Dayno M, Gaspari R. Inferior vena cava displacement during respirophasic ultrasound imaging. Critical Ultrasound Journal 2012; 4 (1): 2-5. doi: 10.1186/2036- 7902-4-18
4. Juhl-Olsen P, Frederiksen CA, Sloth E. Ultrasound assessment of inferior vena cava collapsibility is not a valid measure of preload changes during triggered positive pressure ventilation: a controlled cross-over study. Ultraschall in der Medizin 2012; 33 (2): 152-9. doi: 10.1055/s-0031-1281832
5. Achar SK, Sagar MS, Shetty R, Kini G, Samanth J et al. Respiratory variation in aortic flow peak velocity and inferior vena cava distensibility as indices of fluid responsiveness in anaesthetised and mechanically ventilated children. The Indian Journal of Anaesthesia 2016; 60 (2): 121-6. doi: 10.4103/0019- 5049.176285
6. Nuttall FQ. Body mass index: obesity, BMI, and health: a critical review. Nutrition Today. 2015; 50 (3): 117-128. doi: 10.1097/NT.0000000000000092
7. Campodonico P, Duca A, Rosti V, Travierso C, Brambilla AM et al. PEEP application and breathing pattern influence ecographic IVC collapsibility in normal subjects. Italian Journal Emergency Medicine 2017; 3 (13): 1-8. doi: 10.23832/ ITJEM.2017.025
8. Stawicki SP, Adkins EJ, Eiferman DS, Evans DC, Ali NA et al. Prospective evaluation of intravascular volume status in critically ill patients: does inferior vena cava collapsibility correlate with central venous pressure? Journal of Trauma and Acute Care Surgery 2014; 76 (4): 956-64. doi: 10.1097/ TA.0000000000000152
9. Evans DC, Doraiswamy VA, Prosciak MP, Silviera M, Seamon MJ et al. Complications associated with pulmonary artery catheters: a comprehensive clinical review. Scandinavian Journal of Surgery 2009; 98 (4): 199-208
10. Stawicki SP, Braslow BM, Panebianco NL, Kirkpatrick JN, Gracias VH et al. Intensivist use of hand-carried ultrasonography to measure IVC collapsibility in estimating intravascular volume status: correlations with CVP. Journal of the American College of Surgeons 2009; 209: 55-61. doi: 10.1016/j.jamcollsurg.2009.02.062
11. Ilyas A, Ishtiaq W, Assad S, Ghazanfar H, Mansoor S et al. Correlation of IVC diameter and collapsibility index with central venous pressure in the assessment of intravascular volume in critically ill patients. Cureus 2017; 12 (2): 3-8. doi: 10.7759/cureus.1025
12. Nagdev AD, Merchant RC, Tirado-Gonzalez A, Sisson CA, Murphy MC. Emergency department bedside ultrasonographic measurement of the caval index for noninvasive determination of low central venous pressure. Annals of Emergency Medicine 2010; 55: 290-295.
13. Bauman Z, Coba V, Gassner M, Amponsah D, Gallien J et al. Inferior vena cava collapsibility loses correlation with internal jugular vein collapsibility during increased thoracic or intraabdominal pressure. Journal of Ultrasound 2015; 18 (4): 343-8. doi: 10.1007/s40477-015-0181-2
14. Muller L, Louart G, Bengler C, Fabbro-Peray P, Carr J et al. The intrathoracic blood volume index as an indicator of fluid responsiveness in critically ill patients with acute circulatory failure: a comparison with central venous pressure. Anesthesia & Analgesia 2008; 107: 607-613.
15. Muller L, Bobbia X, Toumi M, Louart G, Molinari N 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. Critical Care 2012; 16 (5): 2-7. doi: 10.1186/cc11672
16. Corl KA, George NR, Romanoff J, Levinson AT, Chheng DB et al. Inferior vena cava collapsibility detects fluid responsiveness among spontaneously breathing critically-ill patients. Journal of Critical Care 2017; 41: 130-137. doi: 10.1016/j. jcrc.2017.05.008
17. Duwat A, Zogheib E, Guinot P, Levy F, Trojette F et al. The gray zone of the qualitative assessment of respiratory changes in inferior vena cava diameter in ICU patients. Critical Care 2014; 18 (1): 2-7. doi: 10.1186/cc13693