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Erschienen in: Intensive Care Medicine 7/2016

23.04.2016 | What's New in Intensive Care

Ten situations where inferior vena cava ultrasound may fail to accurately predict fluid responsiveness: a physiologically based point of view

verfasst von: G. Via, G. Tavazzi, S. Price

Erschienen in: Intensive Care Medicine | Ausgabe 7/2016

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Excerpt

Assessment of the size of the inferior vena cava (IVC) and its change in diameter in response to respiration have been investigated as a tool to screen for severe hypovolaemia [1], predict fluid responsiveness (FR) [2, 3] and assess potential intolerance to fluid loading. IVC size, collapsibility (IVCc) [2] and distensibility (IVCd) [3] have gained acceptance by emergency and intensive care unit (ICU) clinicians as FR predictors in patients with shock [4]. The ease of acquisition, reproducibility of measurements and increasing availability of ultrasound devices have supported the expansion of its use. Conflicting results have also been published [5, 6]. Injudicious application in clinical contexts where these indices have not been specifically tested may, however, mislead. On the basis of physiological principles and available, although limited, scientific evidence, it can be hypothesized that in a number of clinical conditions IVC size and/or respiratory variability may not depend on volume status and may not predict FR accurately. Although not specifically investigated yet, these conditions can be described and grouped on the basis of their main physiological determinant, as follows (Table 1) (pictorial samples are also presented as electronic supplementary material, ESM):
Table 1
Ten conditions potentially affecting inferior vena cava (IVC) ultrasound reliability in predicting fluid responsiveness (FR)
Physiological determinant
Condition affecting IVC ultrasound reliability for FR
Cause of inaccuracy for FR
Type of inaccuracy for FR
Ventilator settings
1. Mechanical ventilation with high PEEP and/or low tidal volumes
Larger IVC size, potentially with systemic venous congestion and low respiratory variations, but coexisting with FR
FN
Patient’s inspiratory efforts
2. Assisted ventilation modalities, NIV, CPAP
Spontaneous breathing activity makes IVC variation unpredictable
FP and FN
3. Varying respiratory pattern in spontaneous breathing
Significant inspiratory effort, producing markedly negative intrathoracic pressures may induce IVCc in absence of FR
FP
Shallow breathing, with small intrathoracic pressure changes, may induce absence of IVCc in presence of FR
FN
Lung hyperinflation
4. Asthma/COPD exacerbation
Lung hyperinflation and auto-PEEP simultaneously reduce venous return and induce IVC distension: this may mimic absence of FR
FN
Forced expiration (“abdominal breathing” causing expiratory collapse) may mimic IVCc
FP
Cardiac conditions impeding venous return
5. Chronic RV dysfunction, severe TR
Chronic enlargement of IVC and reduced IVCc may erroneously rule out FR
FN
6. RV myocardial infarction
RV dilatation and systemic venous congestion (large IVC) may be associated with FR
FN
7. Cardiac tamponade
Marked venous return hindrance: fluid challenge may be a beneficial haemodynamic intervention despite IVC plethora
FN
Increased abdominal pressure
8. Intra-abdominal hypertension
Smaller IVC size, IVCd or IVCc abolition (depending on type respiration/ventilation mode)
FP and FN
Other factors
9. Local mechanical factors
Venous return hindrance, IVC dilatation (stenosis, thrombosis)
FN
IVC compression (masses)
FP
Hindrance to IVC size change (ECMO cannulae, cava filters)
FN
10. Patients with pronounced IVC inspiratory lateral displacement
Migration of IVC imaging plane, false inspiratory size reduction
FP
IVC inferior vena cava, RV right ventricle, PEEP positive end-expiratory pressure, NIV non-invasive ventilation, CPAP continuous positive airway pressure, IVCc IVC collapsibility, IVCd IVC distensibility, COPD chronic obstructive pulmonary disease, TR tricuspid regurgitation, ECMO extracorporeal membrane oxygenation, FN false negative, FP false positive
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Literatur
1.
Zurück zum Zitat Dipti A, Soucy Z, Surana A, Chandra S (2012) Role of inferior vena cava diameter in assessment of volume status: a meta-analysis. Am J Emerg Med 30(1414–1419):e1411 Dipti A, Soucy Z, Surana A, Chandra S (2012) Role of inferior vena cava diameter in assessment of volume status: a meta-analysis. Am J Emerg Med 30(1414–1419):e1411
2.
Zurück zum Zitat Airapetian N, Maizel J, Alyamani O, Mahjoub Y, Lorne E, Levrard M, Ammenouche N, Seydi A, Tinturier F, Lobjoie E, Dupont H, Slama M (2015) Does inferior vena cava respiratory variability predict fluid responsiveness in spontaneously breathing patients? Crit Care 19:400CrossRefPubMedPubMedCentral Airapetian N, Maizel J, Alyamani O, Mahjoub Y, Lorne E, Levrard M, Ammenouche N, Seydi A, Tinturier F, Lobjoie E, Dupont H, Slama M (2015) Does inferior vena cava respiratory variability predict fluid responsiveness in spontaneously breathing patients? Crit Care 19:400CrossRefPubMedPubMedCentral
3.
Zurück zum Zitat Barbier C, Loubieres Y, Schmit C, Hayon J, Ricome JL, Jardin F, Vieillard-Baron A (2004) Respiratory changes in inferior vena cava diameter are helpful in predicting fluid responsiveness in ventilated septic patients. Intensive Care Med 30:1740–1746PubMed Barbier C, Loubieres Y, Schmit C, Hayon J, Ricome JL, Jardin F, Vieillard-Baron A (2004) Respiratory changes in inferior vena cava diameter are helpful in predicting fluid responsiveness in ventilated septic patients. Intensive Care Med 30:1740–1746PubMed
4.
Zurück zum Zitat Zhang Z, Xu X, Ye S, Xu L (2014) Ultrasonographic measurement of the respiratory variation in the inferior vena cava diameter is predictive of fluid responsiveness in critically ill patients: systematic review and meta-analysis. Ultrasound Med Biol 40:845–853CrossRefPubMed Zhang Z, Xu X, Ye S, Xu L (2014) Ultrasonographic measurement of the respiratory variation in the inferior vena cava diameter is predictive of fluid responsiveness in critically ill patients: systematic review and meta-analysis. Ultrasound Med Biol 40:845–853CrossRefPubMed
5.
Zurück zum Zitat Charbonneau H, Riu B, Faron M, Mari A, Kurrek MM, Ruiz J, Geeraerts T, Fourcade O, Genestal M, Silva S (2014) Predicting preload responsiveness using simultaneous recordings of inferior and superior vena cavae diameters. Crit Care 18:473CrossRefPubMedPubMedCentral Charbonneau H, Riu B, Faron M, Mari A, Kurrek MM, Ruiz J, Geeraerts T, Fourcade O, Genestal M, Silva S (2014) Predicting preload responsiveness using simultaneous recordings of inferior and superior vena cavae diameters. Crit Care 18:473CrossRefPubMedPubMedCentral
6.
Zurück zum Zitat Muller L, Bobbia X, Toumi M, Louart G, Molinari N, Ragonnet B, Quintard H, Leone M, Zoric L, Lefrant JY, AzuRea G (2012) Respiratory variations of inferior vena cava diameter to predict fluid responsiveness in spontaneously breathing patients with acute circulatory failure: need for a cautious use. Crit Care 16:R188CrossRefPubMedPubMedCentral Muller L, Bobbia X, Toumi M, Louart G, Molinari N, Ragonnet B, Quintard H, Leone M, Zoric L, Lefrant JY, AzuRea G (2012) Respiratory variations of inferior vena cava diameter to predict fluid responsiveness in spontaneously breathing patients with acute circulatory failure: need for a cautious use. Crit Care 16:R188CrossRefPubMedPubMedCentral
7.
Zurück zum Zitat Jellinek H, Krenn H, Oczenski W, Veit F, Schwarz S, Fitzgerald RD (2000) Influence of positive airway pressure on the pressure gradient for venous return in humans. J Appl Physiol (1985) 88:926–932 Jellinek H, Krenn H, Oczenski W, Veit F, Schwarz S, Fitzgerald RD (2000) Influence of positive airway pressure on the pressure gradient for venous return in humans. J Appl Physiol (1985) 88:926–932
8.
Zurück zum Zitat Baker AK, Partridge RJ, Litton E, Ho KM (2013) Assessment of the plethysmographic variability index as a predictor of fluid responsiveness in critically ill patients: a pilot study. Anaesth Intensive Care 41:736–741PubMed Baker AK, Partridge RJ, Litton E, Ho KM (2013) Assessment of the plethysmographic variability index as a predictor of fluid responsiveness in critically ill patients: a pilot study. Anaesth Intensive Care 41:736–741PubMed
9.
Zurück zum Zitat Juhl-Olsen P, Frederiksen CA, Sloth E (2012) Ultrasound assessment of inferior vena cava collapsibility is not a valid measure of preload changes during triggered positive pressure ventilation: a controlled cross-over study. Ultraschall Med 33:152–159CrossRefPubMed Juhl-Olsen P, Frederiksen CA, Sloth E (2012) Ultrasound assessment of inferior vena cava collapsibility is not a valid measure of preload changes during triggered positive pressure ventilation: a controlled cross-over study. Ultraschall Med 33:152–159CrossRefPubMed
10.
Zurück zum Zitat Gignon L, Roger C, Bastide S, Alonso S, Zieleskiewicz L, Quintard H, Zoric L, Bobbia X, Raux M, Leone M, Lefrant JY, Muller L (2016) Influence of diaphragmatic motion on inferior vena cava diameter respiratory variations in healthy volunteers. Anesthesiology. doi:10.1097/ALN.0000000000001096 Gignon L, Roger C, Bastide S, Alonso S, Zieleskiewicz L, Quintard H, Zoric L, Bobbia X, Raux M, Leone M, Lefrant JY, Muller L (2016) Influence of diaphragmatic motion on inferior vena cava diameter respiratory variations in healthy volunteers. Anesthesiology. doi:10.​1097/​ALN.​0000000000001096​
11.
Zurück zum Zitat Dhainaut JF, Brunet F (1987) Phasic changes of right ventricular ejection fraction in patients with acute exacerbations of chronic obstructive pulmonary disease. Intensive Care Med 13:214–215PubMed Dhainaut JF, Brunet F (1987) Phasic changes of right ventricular ejection fraction in patients with acute exacerbations of chronic obstructive pulmonary disease. Intensive Care Med 13:214–215PubMed
12.
Zurück zum Zitat Mandelbaum A, Ritz E (1996) Vena cava diameter measurement for estimation of dry weight in haemodialysis patients. Nephrol Dial Transpl 11(Suppl 2):24–27CrossRef Mandelbaum A, Ritz E (1996) Vena cava diameter measurement for estimation of dry weight in haemodialysis patients. Nephrol Dial Transpl 11(Suppl 2):24–27CrossRef
13.
Zurück zum Zitat Goldstein JA (2002) Pathophysiology and management of right heart ischemia. J Am Coll Cardiol 40:841–853CrossRefPubMed Goldstein JA (2002) Pathophysiology and management of right heart ischemia. J Am Coll Cardiol 40:841–853CrossRefPubMed
14.
Zurück zum Zitat Cavaliere F, Cina A, Biasucci D, Costa R, Soave M, Gargaruti R, Bonomo L, Proietti R (2011) Sonographic assessment of abdominal vein dimensional and hemodynamic changes induced in human volunteers by a model of abdominal hypertension. Crit Care Med 39:344–348CrossRefPubMed Cavaliere F, Cina A, Biasucci D, Costa R, Soave M, Gargaruti R, Bonomo L, Proietti R (2011) Sonographic assessment of abdominal vein dimensional and hemodynamic changes induced in human volunteers by a model of abdominal hypertension. Crit Care Med 39:344–348CrossRefPubMed
15.
Zurück zum Zitat Blehar DJ, Resop D, Chin B, Dayno M, Gaspari R (2012) Inferior vena cava displacement during respirophasic ultrasound imaging. Crit Ultrasound J 4:18CrossRefPubMedPubMedCentral Blehar DJ, Resop D, Chin B, Dayno M, Gaspari R (2012) Inferior vena cava displacement during respirophasic ultrasound imaging. Crit Ultrasound J 4:18CrossRefPubMedPubMedCentral
Metadaten
Titel
Ten situations where inferior vena cava ultrasound may fail to accurately predict fluid responsiveness: a physiologically based point of view
verfasst von
G. Via
G. Tavazzi
S. Price
Publikationsdatum
23.04.2016
Verlag
Springer Berlin Heidelberg
Erschienen in
Intensive Care Medicine / Ausgabe 7/2016
Print ISSN: 0342-4642
Elektronische ISSN: 1432-1238
DOI
https://doi.org/10.1007/s00134-016-4357-9

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