Keith A Corl1, Naomi R George2, Justin Romanoff3, Andrew T Levinson4, Darin B Chheng2, Roland C Merchant5, Mitchell M Levy6, Anthony M Napoli7. 1. Department of Medicine, Division of Pulmonary Critical Care & Sleep, Alpert Medical School of Brown University, USA; Department of Emergency Medicine, Alpert Medical School of Brown University; School of Public Health of Brown University, Providence, RI, USA. Electronic address: keith_corl@brown.edu. 2. Department of Emergency Medicine, Alpert Medical School of Brown University. 3. School of Public Health of Brown University, Providence, RI, USA. Electronic address: justin_romanoff@alumni.brown.edu. 4. Department of Medicine, Division of Pulmonary Critical Care & Sleep, Alpert Medical School of Brown University, USA. Electronic address: andrew_levinson@brown.edu. 5. Department of Emergency Medicine, Alpert Medical School of Brown University; School of Public Health of Brown University, Providence, RI, USA. Electronic address: rmerchant@lifespan.org. 6. Department of Medicine, Division of Pulmonary Critical Care & Sleep, Alpert Medical School of Brown University, USA. Electronic address: mitchell_levy@brown.edu. 7. Department of Emergency Medicine, Alpert Medical School of Brown University. Electronic address: Anapoli@lifespan.org.
Abstract
PURPOSE: Measurement of inferior vena cava collapsibility (cIVC) by point-of-care ultrasound (POCUS) has been proposed as a viable, non-invasive means of assessing fluid responsiveness. We aimed to determine the ability of cIVC to identify patients who will respond to additional intravenous fluid (IVF) administration among spontaneously breathing critically-ill patients. METHODS: Prospective observational trial of spontaneously breathing critically-ill patients. cIVC was obtained 3cm caudal from the right atrium and IVC junction using POCUS. Fluid responsiveness was defined as a≥10% increase in cardiac index following a 500ml IVF bolus; measured using bioreactance (NICOM™, Cheetah Medical). cIVC was compared with fluid responsiveness and a cIVC optimal value was identified. RESULTS: Of the 124 participants, 49% were fluid responders. cIVC was able to detect fluid responsiveness: AUC=0.84 [0.76, 0.91]. The optimum cutoff point for cIVC was identified as 25% (LR+ 4.56 [2.72, 7.66], LR- 0.16 [0.08, 0.31]). A cIVC of 25% produced a lower misclassification rate (16.1%) for determining fluid responsiveness than the previous suggested cutoff values of 40% (34.7%). CONCLUSION: IVC collapsibility, as measured by POCUS, performs well in distinguishing fluid responders from non-responders, and may be used to guide IVF resuscitation among spontaneously breathing critically-ill patients.
PURPOSE: Measurement of inferior vena cava collapsibility (cIVC) by point-of-care ultrasound (POCUS) has been proposed as a viable, non-invasive means of assessing fluid responsiveness. We aimed to determine the ability of cIVC to identify patients who will respond to additional intravenous fluid (IVF) administration among spontaneously breathing critically-illpatients. METHODS: Prospective observational trial of spontaneously breathing critically-illpatients. cIVC was obtained 3cm caudal from the right atrium and IVC junction using POCUS. Fluid responsiveness was defined as a≥10% increase in cardiac index following a 500ml IVF bolus; measured using bioreactance (NICOM™, Cheetah Medical). cIVC was compared with fluid responsiveness and a cIVC optimal value was identified. RESULTS: Of the 124 participants, 49% were fluid responders. cIVC was able to detect fluid responsiveness: AUC=0.84 [0.76, 0.91]. The optimum cutoff point for cIVC was identified as 25% (LR+ 4.56 [2.72, 7.66], LR- 0.16 [0.08, 0.31]). A cIVC of 25% produced a lower misclassification rate (16.1%) for determining fluid responsiveness than the previous suggested cutoff values of 40% (34.7%). CONCLUSION: IVC collapsibility, as measured by POCUS, performs well in distinguishing fluid responders from non-responders, and may be used to guide IVF resuscitation among spontaneously breathing critically-illpatients.
Authors: Keith A Corl; Nader Azab; Mohammed Nayeemuddin; Alexandra Schick; Thomas Lopardo; Fatima Zeba; Gary Phillips; Grayson Baird; Roland C Merchant; Mitchell M Levy; Michael Blaivas; Adeel Abbasi Journal: J Intensive Care Med Date: 2019-10-14 Impact factor: 3.510
Authors: Stije J Leopold; Aniruddha Ghose; Katherine A Plewes; Subash Mazumder; Luigi Pisani; Hugh W F Kingston; Sujat Paul; Anupam Barua; M Abdus Sattar; Michaëla A M Huson; Andrew P Walden; Patricia C Henwood; Elisabeth D Riviello; Marcus J Schultz; Nicholas P J Day; Asok Kumar Dutta; Nicholas J White; Arjen M Dondorp Journal: PLoS One Date: 2018-12-12 Impact factor: 3.240
Authors: Michael J Lanspa; Rebecca E Burk; Emily L Wilson; Eliotte L Hirshberg; Colin K Grissom; Samuel M Brown Journal: J Intensive Care Date: 2018-08-13
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