Comparison of inferior vena cava collapsibility, distensibility, and delta indices at different positive pressure supports and prediction values of indices for intravascular volume status

Aykut Saritaş,Işıl Köse,Çiler Zi̇nci̇rci̇oğlu,Uğur Uzun,Pelin Uzun Saritaş,Nimet Şenoğlu

doi:10.3906/sag-1810-52

Aykut Saritaş, Işıl Köse + Show 4 more

Open Access

https://doi.org/10.3906/sag-1810-52

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Abstract

Background/aimTo compare the inferior vena cava (IVC) indices, identify their variation rates at positive pressure values and accurate predictive values for the volume status in patients with spontaneous respiration receiving different positive pressure support.Material and methodsThe study included 100 patients who were divided into 4 pressure support groups, according to the different pressure supports received, and 3 volume groups according to their CVP values. Ultrasonography was applied to all of the patients to define their IVC diameters at different pressure supports. Dynamic parameters were derived from the ultrasonographic assessment of the IVC diameter [collapsibility (CI-IVC), distensibility (dIVC), and delta (ΔIVC) indices].ResultsThere were significant differences between the 3 indices (CI-IVC, dIVC, and ΔIVC) according to the pressure groups [(10/5), (10/0), (0/5), (t tube 0/0)]. The median value for the dIVC percentages was ≤18% for all of the positive pressure support hypervolemic groups, apart from the hypervolemic t tube group (19%). For the hypervolemic groups, the best estimation according to the cut-off value appeared to be for the dIVC. Values with the highest sensitivity for differentiation of the hypovolemic individuals were calculated with the dIVC.ConclusionThe dIVC had a more accurate predictive role in predicting the volume status when compared with the CI-IVC and ΔIVC, and may be used reliably with positive pressure supports.

Highlights

For critical patients, determining the intravascular volume status and appropriate fluid management are the most important elements of early targeted treatment [1].There are many methods used to assess the intravascular volume and for successful fluid resuscitation
The best estimation according to the cut-off value appeared to be for the dIVC
The dIVC had a more accurate predictive role in predicting the volume status when compared with the CI-inferior vena cava (IVC) and ΔIVC, and may be used reliably with positive pressure supports

Summary

Introduction

There are many methods used to assess the intravascular volume and for successful fluid resuscitation. Among these monitoring methods, hemodynamic monitoring using ultrasonography (US) remains current due to properties like being noninvasive, ready-to-use, applicable at the bedside, being economic, and being available in most intensive care units [2]. As an alternative to this method for assessment of the intravascular volume status among critical patients, the inferior vena cava collapsibility (CIIVC), distensibility (dIVC), and delta (ΔIVC) indices on. This study, based on these debates about applications in the relevant literature, aimed to compare the IVC indexes, identify their variation rates at positive pressure values, and correlate with the CVP and accurate predictive values for the volume status of patients with spontaneous respiration receiving different positive pressure support

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