Abstract
BackgroundDetermination of a patient’s volume status remains challenging. Ultrasound assessments of the inferior vena cava and lung parenchyma have been shown to reflect fluid status when compared to the more traditional static and dynamic methods. Yet, resource-limited intensive care units (ICUs) may still not have access to bedside ultrasound. The vascular pedicle width (VPW) measured on chest radiographs remains underutilized for fluid assessment. In this study, we aimed to determine the correlation between ultrasound assessment and vascular pedicle width and to identify a discriminant value that predicted a fluid replete state.MethodsEighty-four data points of simultaneous VPW and inferior vena cava measurements were collected on mechanically ventilated patients. VPW measurements were compared with lung comet scores, fluid balance, and a composite variable of inferior vena cava diameter greater than or equal to 2 cm and variability less than 15 %.ResultsA VPW of 64 mm accurately predicted fluid repletion with a positive predictive value equal to 88.5 % and an area under the curve (AUC) of 0.843, 95 % CI 0.75–0.93, p < 0.001. VPW closely correlated with inferior vena cava diameter (Pearson’s r = 0.64, p = <0.001). Poor correlations were observed between VPW and lung comet score, Pearson’s r = 0.12, p = 0.26, fluid balance, Pearson’s r = 0.3, p = 0.058, and beta natriuretic peptide, Pearson’s r = 0.12, p = 0.26.ConclusionsThis study shows a high predictive ability of the VPW for fluid repletion, as compared to an accepted method of volume assessment. Given the relationship of fluid overload and mortality, these results may assist fluid resuscitation in resource-limited intensive care units.
Highlights
Determination of a patient’s volume status remains challenging
The reliability and ease of measurement of inferior vena cava (IVC) and lung parenchyma ultrasound has led to Salahuddin et al Journal of Intensive Care (2015) 3:55 widespread adoption by intensive care unit (ICU) physicians to assist in bedside assessment of volume status
It is measured and has been shown to correlate well with invasive hemodynamic measurements [36,37,38]. We carried out this prospective, cross-sectional study to identify vascular pedicle width measurements that could discriminate fluid repletion as defined by inferior vena cava ultrasound measurements and fluid overload as defined by lung water on ultrasound
Summary
Determination of a patient’s volume status remains challenging. Ultrasound assessments of the inferior vena cava and lung parenchyma have been shown to reflect fluid status when compared to the more traditional static and dynamic methods. Resource-limited intensive care units (ICUs) may still not have access to bedside ultrasound. We aimed to determine the correlation between ultrasound assessment and vascular pedicle width and to identify a discriminant value that predicted a fluid replete state. A variety of tools, such as central venous and pulmonary capillary wedge pressures, Salahuddin et al Journal of Intensive Care (2015) 3:55 widespread adoption by ICU physicians to assist in bedside assessment of volume status. The vascular pedicle width (VPW) as seen on chest radiographs represents the mediastinal silhouette of the central vessels. It is measured and has been shown to correlate well with invasive hemodynamic measurements [36,37,38]. We carried out this prospective, cross-sectional study to identify vascular pedicle width measurements that could discriminate fluid repletion as defined by inferior vena cava ultrasound measurements and fluid overload as defined by lung water on ultrasound
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
