Dorota Sobczyk1, Krzysztof Nycz2, Pawel Andruszkiewicz3. 1. Department of Interventional Cardiology, John Paul II Hospital, Krakow, Poland. Electronic address: dorotasobczyk@yahoo.com. 2. Department of Interventional Cardiology, John Paul II Hospital, Krakow, Poland. 3. the 2nd Department of Anaesthesiology and Intensive Care, Warsaw Medical University, Warsaw, Poland.
Abstract
OBJECTIVE: To assess validity of respiratory variation of inferior vena cava (IVC) diameter to predict fluid responsiveness and guide fluid therapy in mechanically ventilated patients during the first 6 hours after elective cardiac surgery. DESIGN: Prospective observational case series study. SETTING: Single-center hospital. PATIENTS: 50 consecutive patients undergoing elective cardiac surgery. INTERVENTIONS: Transthoracic bedside echocardiography. MEASUREMENTS AND MAIN RESULTS: Parameters derived from ultrasonographic assessment of the IVC diameter (collapsibility index [CI], distensibility index [DI], and IVC/aorta index). In the whole study group, change in fluid balance correlated with change in IVC maximum diameter (p = 0.034, r = 0.176). IVC-CI and IVC-DI correlated with IVC/aorta index. A weak correlation between central venous pressure (CVP) and IVC-derived parameters (IVC-CI and IVC-DI) was noticed. Despite statistical significance (p<0.05), all observed correlations expressed low statistical power (r<0.21). There were no statistically significant differences between fluid responders and nonresponders in relation to clinical parameters, CVP, ultrasound IVC measurement, and IVC-derived indices. CONCLUSION: Dynamic IVC-derived parameters (IVC-CI, IVC-DI, and IVC/aorta index) and CVP are not reliable predictors of fluid responsiveness in the first 6 hours after cardiac surgery. Complexity of physiologic factors modulating cardiac performance in this group may be responsible for the difficulty in finding a plausible monitoring tool for fluid guidance. Bedside ultrasonographic measurement of IVC is unable to predict fluid responsiveness in the first 6 hours after cardiac surgery.
OBJECTIVE: To assess validity of respiratory variation of inferior vena cava (IVC) diameter to predict fluid responsiveness and guide fluid therapy in mechanically ventilated patients during the first 6 hours after elective cardiac surgery. DESIGN: Prospective observational case series study. SETTING: Single-center hospital. PATIENTS: 50 consecutive patients undergoing elective cardiac surgery. INTERVENTIONS: Transthoracic bedside echocardiography. MEASUREMENTS AND MAIN RESULTS: Parameters derived from ultrasonographic assessment of the IVC diameter (collapsibility index [CI], distensibility index [DI], and IVC/aorta index). In the whole study group, change in fluid balance correlated with change in IVC maximum diameter (p = 0.034, r = 0.176). IVC-CI and IVC-DI correlated with IVC/aorta index. A weak correlation between central venous pressure (CVP) and IVC-derived parameters (IVC-CI and IVC-DI) was noticed. Despite statistical significance (p<0.05), all observed correlations expressed low statistical power (r<0.21). There were no statistically significant differences between fluid responders and nonresponders in relation to clinical parameters, CVP, ultrasound IVC measurement, and IVC-derived indices. CONCLUSION: Dynamic IVC-derived parameters (IVC-CI, IVC-DI, and IVC/aorta index) and CVP are not reliable predictors of fluid responsiveness in the first 6 hours after cardiac surgery. Complexity of physiologic factors modulating cardiac performance in this group may be responsible for the difficulty in finding a plausible monitoring tool for fluid guidance. Bedside ultrasonographic measurement of IVC is unable to predict fluid responsiveness in the first 6 hours after cardiac surgery.
Authors: R F Trauzeddel; M Nordine; H V Groesdonk; G Michels; R Pfister; D A Reuter; T W L Scheeren; C Berger; S Treskatsch Journal: Anaesthesist Date: 2021-03-03 Impact factor: 1.041
Authors: R F Trauzeddel; M Ertmer; M Nordine; H V Groesdonk; G Michels; R Pfister; D Reuter; T W L Scheeren; C Berger; S Treskatsch Journal: J Clin Monit Comput Date: 2020-05-26 Impact factor: 2.502