Keith A Corl1, Nader Azab1, Mohammed Nayeemuddin1, Alexandra Schick2, Thomas Lopardo3, Fatima Zeba4, Gary Phillips5, Grayson Baird6, Roland C Merchant7,8, Mitchell M Levy1, Michael Blaivas9, Adeel Abbasi1,7. 1. Department of Medicine, 12321Alert Medical School of Brown University, Providence, RI, USA. 2. Department of Emergency Medicine, 12321Alpert Medical School of Brown University, Providence, RI, USA. 3. 12321Alpert Medical School of Brown University, the Brown University School of Public Health, Providence, RI, USA. 4. Department of Medicine, Kent Hospital, 12321Alpert Medical School of Brown University, Warwick, RI, USA. 5. Center for Biostatistics, Department of Biomedical Informatics, Ohio State University, Columbus, Ohio, USA. 6. Lifespan Biostatistics Core, Rhode Island Hospital, Providence, RI, USA. 7. 6752Brown University School of Public Health, Providence, RI, USA. 8. Department of Emergency Medicine, 1861Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA. 9. Department of Emergency Medicine, St Francis Hospital, 2629University of South Carolina School of Medicine, Columbus, SC, USA.
Abstract
OBJECTIVES: Inferior vena cava collapsibility (cIVC) measured by point-of-care ultrasound (POCUS) has been proposed as a noninvasive means of assessing fluid responsiveness. We aimed to prospectively evaluate the performance of a 25% cIVC cutoff value to detect fluid responsiveness among spontaneously breathing intensive care unit (ICU) patients when assessed with POCUS by novice versus expert physician sonologists. METHODS: Prospective observational study of spontaneously breathing ICU patients. Fluid responsiveness was defined as a >10% increase in cardiac index following a 500 mL fluid bolus, measured by bioreactance. Novice sonologist measured cIVC with POCUS. Their measurements were later compared to an expert physician sonologist who independently reviewed the POCUS images and assessed cIVCs. RESULTS: Of the 85 participants, 44 (52%) were fluid responders. A 25% cIVC cutoff value performed better when assessed by expert sonologists than novice physician sonologists (receiver-operator characteristic curve, ROC = 0.82 [0.74-0.88] vs ROC = 0.69 [0.60-0.77]). CONCLUSIONS: A 25% cIVC cutoff value measured by POCUS detects fluid responsiveness. However, the experience of the physician sonologist affects test performance and should be considered when interpreting and clinically using cIVC to direct intravenous fluid resuscitation.
OBJECTIVES: Inferior vena cava collapsibility (cIVC) measured by point-of-care ultrasound (POCUS) has been proposed as a noninvasive means of assessing fluid responsiveness. We aimed to prospectively evaluate the performance of a 25% cIVC cutoff value to detect fluid responsiveness among spontaneously breathing intensive care unit (ICU) patients when assessed with POCUS by novice versus expert physician sonologists. METHODS: Prospective observational study of spontaneously breathing ICU patients. Fluid responsiveness was defined as a >10% increase in cardiac index following a 500 mL fluid bolus, measured by bioreactance. Novice sonologist measured cIVC with POCUS. Their measurements were later compared to an expert physician sonologist who independently reviewed the POCUS images and assessed cIVCs. RESULTS: Of the 85 participants, 44 (52%) were fluid responders. A 25% cIVC cutoff value performed better when assessed by expert sonologists than novice physician sonologists (receiver-operator characteristic curve, ROC = 0.82 [0.74-0.88] vs ROC = 0.69 [0.60-0.77]). CONCLUSIONS: A 25% cIVC cutoff value measured by POCUS detects fluid responsiveness. However, the experience of the physician sonologist affects test performance and should be considered when interpreting and clinically using cIVC to direct intravenous fluid resuscitation.
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