Assessment of fluid responsiveness by inferior vena cava diameter variation in post-pneumonectomy patients.

Yan Wang,Hongning Wu,Runfeng Wang,Cheng Du,Ying Wang,Yinghou Jiang

doi:10.1111/echo.14172

Yan Wang, Hongning Wu + Show 4 more

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https://doi.org/10.1111/echo.14172

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Journal: Echocardiography	Publication Date: Oct 18, 2018
Citations: 5	License type: CC BY 4.0

Affiliation: Nanjing Chest Hospital

Abstract

AimFirst, the inferior vena cava dilatation index (DIVC) was measured by ultrasound, and then the reliability of DIVC as an indicator to predict volume responsiveness in patients undergoing mechanical ventilation after pneumonectomy was evaluated.MethodsPulse indicator continuous cardiac output (Picco) as gold standard was performed to sedated mechanically ventilated post‐pneumonectomy patients in intensive care unit of Nanjing Thoracic Hospital from August 2014 to December 2016. Meanwhile, ultrasound measurement to inferior vena cava (IVC) diameter at the end inspiration (D max) and the end of expiration (D min) was performed. DIVC = (D max − D min)/D min. Above values were recorded at baseline and then after fluid resuscitation challenge (7 mL/kg hydroxyethyl starch). An increase in cardiac index of more than 15% was used as the standard for fluid responsiveness. Patients were divided into responsive group and non‐responsive group. A receiver operating characteristic (ROC) curve was then used to determine the sensitivity and specificity of DIVC in predicting fluid responsiveness after pneumonectomy.ResultsEighteen patients were enrolled. 10 patients were divided into responsive group and eight in non‐responsive group. DIVC in responsive group was significantly higher than in non‐responsive group (P < 0.01). By setting DIVC ≥ 15% as a measure of fluid responsiveness, sensitivity was 81.8% and specificity was 85.7%.ConclusionDIVC is a reliable indicator of capacity responsiveness in mechanically ventilated post‐pneumonectomy patients.

Highlights

Pneumonectomy is a common procedure in thoracic surgery and involves perioperative risks of cardiac and pulmonary dysfunction associated with significant mortality.[1]
Ultrasound has been widely reported as a modality for predicting fluid responsiveness through measurement of variation in the diameter of the inferior vena cava diameter in patients with sepsis,[3] subarachnoid hemorrhage,[4] and trauma.[5]
This study was designed to investigate the reliability of inferior vena cava diameter variation in predicting fluid responsiveness in post- pneumonectomy patients (Figure 1)

Summary

Introduction

Pneumonectomy is a common procedure in thoracic surgery and involves perioperative risks of cardiac and pulmonary dysfunction associated with significant mortality.[1]. Perioperative mismanagement of fluid resuscitation is an important factor contributing to poor outcomes.[2]. Ultrasound has been widely reported as a modality for predicting fluid responsiveness through measurement of variation in the diameter of the inferior vena cava diameter in patients with sepsis,[3] subarachnoid hemorrhage,[4] and trauma.[5]. This study was designed to investigate the reliability of inferior vena cava diameter variation in predicting fluid responsiveness in post- pneumonectomy patients (Figure 1)

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