Philippe Vignon1,2,3, Xavier Repessé4, Emmanuelle Bégot1,2, Julie Léger5, Christophe Jacob6, Koceila Bouferrache7, Michel Slama8, Gwenaël Prat6, Antoine Vieillard-Baron4,9,10. 1. 1 Medical-Surgical Intensive Care Unit and. 2. 2 INSERM CIC 1435, Limoges University Hospital, Limoges, France. 3. 3 Faculty of Medicine, University of Limoges, Limoges, France. 4. 4 Intensive Care Unit, Assistance Publique-Hôpitaux de Paris, University Hospital Ambroise Paré, Boulogne-Billancourt, France. 5. 5 INSERM CIC 1415, Tours University Hospital, Tours, France. 6. 6 Medical Intensive Care Unit, Brest University Hospital, Brest, France. 7. 7 Medical-Surgical Intensive Care Unit, Foch Hospital, Paris, France. 8. 8 Medical Intensive Care Unit, Amiens University Hospital, Amiens, France. 9. 9 Faculty of Medicine Paris Ile-de-France Ouest, University of Versailles Saint-Quentin en Yvelines, Saint-Quentin en Yvelines, France; and. 10. 10 INSERM U-1018, CESP, Team 5, University of Versailles Saint-Quentin en Yvelines, Villejuif, France.
Abstract
RATIONALE: Assessment of fluid responsiveness relies on dynamic echocardiographic parameters that have not yet been compared in large cohorts. OBJECTIVES: To determine the diagnostic accuracy of dynamic parameters used to predict fluid responsiveness in ventilated patients with a circulatory failure of any cause. METHODS: In this multicenter prospective study, respiratory variations of superior vena cava diameter (∆SVC) measured using transesophageal echocardiography, of inferior vena cava diameter (∆IVC) measured using transthoracic echocardiography, of the maximal Doppler velocity in left ventricular outflow tract (∆VmaxAo) measured using either approach, and pulse pressure variations (∆PP) were recorded with the patient in the semirecumbent position. In each patient, a passive leg raise was performed and an increase of aortic velocity time integral greater than or equal to 10% defined fluid responsiveness. MEASUREMENTS AND MAIN RESULTS: Among 540 patients (379 men; age, 65 ± 13 yr; Simplified Acute Physiological Score II, 59 ± 18; Sequential Organ Failure Assessment, 10 ± 3), 229 exhibited fluid responsiveness (42%). ∆PP, ∆VmaxAo, ∆SVC, and ∆IVC could be measured in 78.5%, 78.0%, 99.6%, and 78.1% of cases, respectively. ∆SVC greater than or equal to 21%, ∆VmaxAo greater than or equal to 10%, and ∆IVC greater than or equal to 8% had a sensitivity of 61% (95% confidence interval, 57-66%), 79% (75-83%), and 55% (50-59%), respectively, and a specificity of 84% (81-87%), 64% (59-69%), and 70% (66-75%), respectively. The area under the receiver operating characteristic curve of ∆SVC was significantly greater than that of ∆IVC (P = 0.02) and ∆PP (P = 0.01). CONCLUSIONS: ∆VmaxAo had the best sensitivity and ∆SVC the best specificity in predicting fluid responsiveness. ∆SVC had a greater diagnostic accuracy than ∆IVC and ∆PP, but its measurement requires transesophageal echocardiography.
RATIONALE: Assessment of fluid responsiveness relies on dynamic echocardiographic parameters that have not yet been compared in large cohorts. OBJECTIVES: To determine the diagnostic accuracy of dynamic parameters used to predict fluid responsiveness in ventilated patients with a circulatory failure of any cause. METHODS: In this multicenter prospective study, respiratory variations of superior vena cava diameter (∆SVC) measured using transesophageal echocardiography, of inferior vena cava diameter (∆IVC) measured using transthoracic echocardiography, of the maximal Doppler velocity in left ventricular outflow tract (∆VmaxAo) measured using either approach, and pulse pressure variations (∆PP) were recorded with the patient in the semirecumbent position. In each patient, a passive leg raise was performed and an increase of aortic velocity time integral greater than or equal to 10% defined fluid responsiveness. MEASUREMENTS AND MAIN RESULTS: Among 540 patients (379 men; age, 65 ± 13 yr; Simplified Acute Physiological Score II, 59 ± 18; Sequential Organ Failure Assessment, 10 ± 3), 229 exhibited fluid responsiveness (42%). ∆PP, ∆VmaxAo, ∆SVC, and ∆IVC could be measured in 78.5%, 78.0%, 99.6%, and 78.1% of cases, respectively. ∆SVC greater than or equal to 21%, ∆VmaxAo greater than or equal to 10%, and ∆IVC greater than or equal to 8% had a sensitivity of 61% (95% confidence interval, 57-66%), 79% (75-83%), and 55% (50-59%), respectively, and a specificity of 84% (81-87%), 64% (59-69%), and 70% (66-75%), respectively. The area under the receiver operating characteristic curve of ∆SVC was significantly greater than that of ∆IVC (P = 0.02) and ∆PP (P = 0.01). CONCLUSIONS: ∆VmaxAo had the best sensitivity and ∆SVC the best specificity in predicting fluid responsiveness. ∆SVC had a greater diagnostic accuracy than ∆IVC and ∆PP, but its measurement requires transesophageal echocardiography.
Authors: Diego Ugalde; Pierre-Alexandre Haruel; Mathieu Godement; Amélie Prigent; Antoine Vieillard-Baron Journal: Intensive Care Med Date: 2019-04-25 Impact factor: 17.440
Authors: P Mayo; R Arntfield; M Balik; P Kory; G Mathis; G Schmidt; M Slama; G Volpicelli; N Xirouchaki; A McLean; A Vieillard-Baron Journal: Intensive Care Med Date: 2017-03-07 Impact factor: 17.440
Authors: Daniel De Backer; Jan Bakker; Maurizio Cecconi; Ludhmila Hajjar; Da Wei Liu; Suzanna Lobo; Xavier Monnet; Andrea Morelli; Sheila Neinan Myatra; Azriel Perel; Michael R Pinsky; Bernd Saugel; Jean-Louis Teboul; Antoine Vieillard-Baron; Jean-Louis Vincent Journal: Intensive Care Med Date: 2018-05-03 Impact factor: 17.440