Respiratory changes of the inferior vena cava diameter predict fluid responsiveness in spontaneously breathing patients with cardiac arrhythmias

• DOI: 10.1186/s13613-018-0427-1
• Publication Date: 2018-08-02T09:21:08Z
• Authors: Perrine Bortolotti; Delphine Colling; Vincent Colas; Benoit Voisin; Florent Dewavrin; Julien Poissy; Patrick Girardie; Maeva Kyheng; Fabienne Saulnier; Raphael Favory; Sebastien Preau
• Keywords: RC86-88.9; [SDV]Life Sciences [q-bio]; Research; Fluid responsiveness; Medical emergencies. Critical care. Intensive care. First aid; Atrial fibrillation; [SDV.MHEP.CSC] Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system; 03 medical and health sciences; 0302 clinical medicine; Echocardiography;Ultrasound;Sepsis;Fluid responsiveness;Inferior vena cava;Atrial fibrillation;Arrhythmia;Hemodynamic; [SDV.MHEP.CSC]Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system; [SDV.MHEP.MI]Life Sciences [q-bio]/Human health and pathology/Infectious diseases; Echocardiography; Sepsis; Ultrasound; [SDV.MHEP.MI] Life Sciences [q-bio]/Human health and pathology/Infectious diseases; Hemodynamic; Inferior vena cava; Arrhythmia

Whether the respiratory changes of the inferior vena cava diameter during a deep standardized inspiration can reliably predict fluid responsiveness in spontaneously breathing patients with cardiac arrhythmia is unknown.This prospective two-center study included nonventilated arrhythmic patients with infection-induced acute circulatory failure. Hemodynamic status was assessed at baseline and after a volume expansion of 500 mL 4% gelatin. The inferior vena cava diameters were measured with transthoracic echocardiography using the bi-dimensional mode on a subcostal long-axis view. Standardized respiratory cycles consisted of a deep inspiration with concomitant control of buccal pressures and passive exhalation. The collapsibility index of the inferior vena cava was calculated as [(expiratory-inspiratory)/expiratory] diameters.Among the 55 patients included in the study, 29 (53%) were responders to volume expansion. The areas under the ROC curve for the collapsibility index and inspiratory diameter of the inferior vena cava were both of 0.93 [95% CI 0.86; 1]. A collapsibility index ≥ 39% predicted fluid responsiveness with a sensitivity of 93% and a specificity of 88%. An inspiratory diameter < 11 mm predicted fluid responsiveness with a sensitivity of 83% and a specificity of 88%. A correlation between the inspiratory effort and the inferior vena cava collapsibility was found in responders but was absent in nonresponder patients.In spontaneously breathing patients with cardiac arrhythmias, the collapsibility index and inspiratory diameter of the inferior vena cava assessed during a deep inspiration may be noninvasive bedside tools to predict fluid responsiveness in acute circulatory failure related to infection. These results, obtained in a small and selected population, need to be confirmed in a larger-scale study before considering any clinical application.