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Chin WV, Ngai MMI, See KC. Venous excess ultrasound: A mini-review and practical guide for its application in critically ill patients. World J Crit Care Med 2025; 14:101708. [DOI: 10.5492/wjccm.v14.i2.101708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2024] [Revised: 01/21/2025] [Accepted: 02/17/2025] [Indexed: 02/27/2025] Open
Abstract
Advancements in healthcare technology have improved mortality rates and extended lifespans, resulting in a population with multiple comorbidities that complicate patient care. Traditional assessments often fall short, underscoring the need for integrated care strategies. Among these, fluid management is particularly challenging due to the difficulty in directly assessing volume status especially in critically ill patients who frequently have peripheral oedema. Effective fluid management is essential for optimal tissue oxygen delivery, which is crucial for cellular metabolism. Oxygen transport is dependent on arterial oxygen levels, haemoglobin concentration, and cardiac output, with the latter influenced by preload, afterload, and cardiac contractility. A delicate balance of these factors ensures that the cardiovascular system can respond adequately to varying physiological demands, thereby safeguarding tissue oxygenation and overall organ function during states of stress or illness. The Venous Excess Ultrasound (VExUS) Grading System is instrumental in evaluating fluid intolerance, providing detailed insights into venous congestion and fluid status. It was originally developed to assess the risk of acute kidney injury in postoperative cardiac patients, but its versatility has enabled broader applications in nephrology and critical care settings. This mini review explores VExUS’s application and its impact on fluid management and patient outcomes in critically ill patients.
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Affiliation(s)
- Wei Ven Chin
- Acute Internal Medicine, Department of Medical, Sarawak General Hospital, Kuching 93586, Sarawak, Malaysia
| | - Melissa Mei Ing Ngai
- Department of Pharmacy, National University Hospital, Singapore 119074, Singapore
| | - Kay Choong See
- Department of Medicine, National University Hospital, Singapore 119228, Singapore
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Liu Y, Han Z, Wang J, Wang Q, Qie X. Inferior vena cava collapsibility index for predicting hypotension after spinal anesthesia in patients undergoing total knee arthroplasty. DIE ANAESTHESIOLOGIE 2024; 73:735-742. [PMID: 39382631 DOI: 10.1007/s00101-024-01468-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Revised: 07/14/2024] [Accepted: 07/29/2024] [Indexed: 10/10/2024]
Abstract
OBJECTIVE This study aimed to identify risk factors associated with hypotension in patients undergoing total knee arthroplasty (TKA) under spinal anesthesia. METHOD A total of 200 patients (50-75 years of age) who underwent elective TKA under spinal anesthesia between October 2023 and January 2024 were enrolled. Patients were divided into two groups (hypotensive and nonhypotensive) depending on the occurrence of postspinal anesthesia hypotension (PSAH). Patient characteristics (age, sex, body mass index, and medical history), blood pressure, heart rate, and ultrasound data before anesthesia were documented. Multivariate logistic regression models were used to determine risk factors for hypotension after spinal anesthesia. Furthermore, a nomogram was constructed according to independent predictive factors. The area under the curve (AUC) and calibration curves were employed to assess the performance of the nomogram. RESULTS In total, 175 patients were analyzed and 79 (45.1%) developed PSAH. Logistic regression analysis revealed that variability of the inferior vena cava (odds ratio, OR, 1.147; 95% confidence interval, CI: 1.090-1.207; p < 0.001) and systolic arterial blood pressure (SABP, OR 1.078; 95% CI: 1.043-1.115; p < 0.001) were independent risk factors for PSAH. Receiver operating characteristic (ROC) curve analysis showed that the AUC of the inferior vena cava collapsibility index (IVCCI) and SABP alone were 0.806 and 0.701, respectively, while the AUC of both combined was 0.841. Specifically, an IVCCI of > 37.5% and systolic arterial blood pressure of > 157 mm Hg were considered threshold values. Furthermore, we found that the combination had a better predictive value with higher AUC value, sensitivity, and specificity than the index alone. The nomogram model and calibration curves demonstrated the satisfactory predictive performance of the model. CONCLUSION Elevated preoperative systolic arterial blood pressure and a higher IVCCI were identified as independent risk factors for hypotension in patients receiving spinal anesthesia, which may help guide personalized treatment.
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Affiliation(s)
- Yang Liu
- Department of Anesthesiology, Hebei Province Cangzhou Hospital of Integrated Traditional and Western Medicine, Hebei Province Key Laboratory of Integrated Traditional and Western Medicine in Neurological Rehabilitation, Cangzhou, China
| | - Ziyu Han
- Basic Medical College, Hebei Medical University, Shijiazhuang, Hebei, China
| | - Jianhua Wang
- Department of Anesthesiology, Hebei Province Cangzhou Hospital of Integrated Traditional and Western Medicine, Hebei Province Key Laboratory of Integrated Traditional and Western Medicine in Neurological Rehabilitation, Cangzhou, China
| | - Qiujun Wang
- Department of Anesthesiology, the Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Xiaojuan Qie
- Department of Anesthesiology, the Third Hospital of Hebei Medical University, Shijiazhuang, China.
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Cardillo JH, Zersen KM, Cavanagh AA. Point of care ultrasound measurement of paralumbar caudal vena cava diameter and caudal vena cava to aortic ratio in hypovolemic dogs. Front Vet Sci 2024; 11:1467043. [PMID: 39529853 PMCID: PMC11551537 DOI: 10.3389/fvets.2024.1467043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2024] [Accepted: 10/08/2024] [Indexed: 11/16/2024] Open
Abstract
Background Accurate assessment of intravascular volume is critical for precise fluid prescription. In people, bedside or point of care ultrasound is used to measure the inferior vena cava, with or without paired aortic measurement, to estimate intravascular volume. Objective To determine if point of care ultrasound measurement of the caudal vena cava (CVC) diameter or the CVC diameter to the abdominal aorta (Ao) diameter (CVC:Ao) at the paralumbar view are associated with changes in intravascular volume, mean arterial pressure (MAP), or cardiac output in normovolemic and hypovolemic dogs. Animals 8 purpose-bred dogs. Methods Pressure-targeted hemorrhagic shock was induced in purpose-bred dogs under general anesthesia. Dogs were exsanguinated to a mean arterial pressure of 40 mmHg, or a maximum 60% blood volume lost, then auto-transfused shed blood. At a left paralumbar view, longitudinal plane measurements of the abdominal CVC diameter and aortic diameter were obtained. Measurements were performed at 4 timepoints: baseline under anesthesia (TP1), after hemorrhagic shock was induced (TP2), after ½ of shed blood had been re-transfused (TP3), and post-resuscitation with completed re-transfusion (TP4). Additional variables collected included cardiac output using thermodilution and arterial blood pressure. Results CVC:Ao was not significantly different between timepoints and was not associated with changes in CO (p = 0.28) or MAP (p = 0.50). CVC diameter was significantly different between baseline (TP1) and hemorrhagic shock (TP2). CVC diameter was significantly different at TP2 compared to TP1 after controlling for the effect of CO (p = 0.03) and MAP (p = 0.001). Aortic diameter was also significantly different at TP2 (p = 0.002, p = 0.001) and TP3 (p = 0.023, p = 0.017) compared to TP1 after controlling for CO and MAP. Conclusions and clinical importance Obtaining point of care ultrasound images for CVC:Ao measurement was feasible. With a marked decrease in intravascular volume, both CVC and Ao diameter decreased, resulting in an unchanged CVC:Ao. Despite changes in CVC and Ao diameters, these changes were not associated with measured changes in CO, emphasizing that CO is not a direct estimate of intravascular volume and is affected by many compensatory mechanisms. Additional studies are needed to determine the most accurate method for bedside measurement of intravascular volume status.
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Affiliation(s)
| | | | - Amanda A. Cavanagh
- Department of Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, CO, United States
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Pérez C, Diaz-Caicedo D, Almanza Hernández DF, Moreno-Araque L, Yepes AF, Carrizosa Gonzalez JA. Critical Care Ultrasound in Shock: A Comprehensive Review of Ultrasound Protocol for Hemodynamic Assessment in the Intensive Care Unit. J Clin Med 2024; 13:5344. [PMID: 39336831 PMCID: PMC11432640 DOI: 10.3390/jcm13185344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2024] [Revised: 07/19/2024] [Accepted: 07/26/2024] [Indexed: 09/30/2024] Open
Abstract
Shock is a life-threatening condition that requires prompt recognition and treatment to prevent organ failure. In the intensive care unit, shock is a common presentation, and its management is challenging. Critical care ultrasound has emerged as a reliable and reproducible tool in diagnosing and classifying shock. This comprehensive review proposes an ultrasound-based protocol for the hemodynamic assessment of shock to guide its management in the ICU. The protocol classifies shock as either low or high cardiac index and differentiates obstructive, hypovolemic, cardiogenic, and distributive etiologies. In distributive shock, the protocol proposes a hemodynamic-based approach that considers the presence of dynamic obstruction, fluid responsiveness, fluid tolerance, and ventriculo-arterial coupling. The protocol gives value to quantitative measures based on critical care ultrasound to guide hemodynamic management. Using critical care ultrasound for a comprehensive hemodynamic assessment can help clinicians diagnose the etiology of shock and define the appropriate treatment while monitoring the response. The protocol's use in the ICU can facilitate prompt recognition, diagnosis, and management of shock, ultimately improving patient outcomes.
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Affiliation(s)
- Camilo Pérez
- Critical and Intensive Care Medicine Department, Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá 110111, Colombia
- School of Medicine and Health Sciences, Universidad del Rosario, Bogotá 111711, Colombia
| | - Diana Diaz-Caicedo
- Critical and Intensive Care Medicine Department, Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá 110111, Colombia
- School of Medicine and Health Sciences, Universidad del Rosario, Bogotá 111711, Colombia
| | - David Fernando Almanza Hernández
- Critical and Intensive Care Medicine Department, Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá 110111, Colombia
- School of Medicine and Health Sciences, Universidad del Rosario, Bogotá 111711, Colombia
| | - Lorena Moreno-Araque
- Critical and Intensive Care Medicine Department, Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá 110111, Colombia
- School of Medicine and Health Sciences, Universidad del Rosario, Bogotá 111711, Colombia
| | - Andrés Felipe Yepes
- Critical and Intensive Care Medicine Department, Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá 110111, Colombia
- School of Medicine and Health Sciences, Universidad del Rosario, Bogotá 111711, Colombia
| | - Jorge Armando Carrizosa Gonzalez
- Critical and Intensive Care Medicine Department, Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá 110111, Colombia
- School of Medicine and Health Sciences, Universidad del Rosario, Bogotá 111711, Colombia
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Dana E, Arzola C, Khan JS. Prevention of hypotension after induction of general anesthesia using point-of-care ultrasound to guide fluid management: a randomized controlled trial. Can J Anaesth 2024; 71:1219-1228. [PMID: 38480632 DOI: 10.1007/s12630-024-02748-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 11/01/2023] [Accepted: 12/27/2023] [Indexed: 06/16/2024] Open
Abstract
PURPOSE Hypotension after induction of general anesthesia (GAIH) is common and is associated with postoperative complications including increased mortality. Collapsibility of the inferior vena cava (IVC) has good performance in predicting GAIH; however, there is limited evidence whether a preoperative fluid bolus in patients with a collapsible IVC can prevent this drop in blood pressure. METHODS We conducted a single-centre randomized controlled trial with adult patients scheduled to undergo elective noncardiac surgery under general anesthesia (GA). Patients underwent a preoperative point-of-care ultrasound scan (POCUS) to identify those with a collapsible IVC (IVC collapsibility index ≥ 43%). Individuals with a collapsible IVC were randomized to receive a preoperative 500 mL fluid bolus or routine care (control group). Surgical and anesthesia teams were blinded to the results of the scan and group allocation. Hypotension after induction of GA was defined as the use of vasopressors/inotropes or a decrease in mean arterial pressure < 65 mm Hg or > 25% from baseline within 20 min of induction of GA. RESULTS Forty patients (20 in each group) were included. The rate of hypotension after induction of GA was significantly reduced in those receiving preoperative fluids (9/20, 45% vs 17/20, 85%; relative risk, 0.53; 95% confidence interval, 0.32 to 0.89; P = 0.02). The mean (standard deviation) time to complete POCUS was 4 (2) min, and the duration of fluid bolus administration was 14 (5) min. Neither surgical delays nor adverse events occurred as a result of the study intervention. CONCLUSION A preoperative fluid bolus in patients with a collapsible IVC reduced the incidence of GAIH without associated adverse effects. STUDY REGISTRATION ClinicalTrials.gov (NCT05424510); first submitted 15 June 2022.
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Affiliation(s)
- Elad Dana
- Department of Anesthesia, Intensive Care and Pain Medicine, Meir Medical Center, Kfar Saba, Israel.
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
- Mount Sinai Hospital, Toronto, ON, Canada.
- Mount Sinai Hospital, 600 University Avenue, Room 20-400, Toronto, ON, M5G 1X5, Canada.
| | - Cristian Arzola
- Mount Sinai Hospital, Toronto, ON, Canada
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, ON, Canada
| | - James S Khan
- Mount Sinai Hospital, Toronto, ON, Canada
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, ON, Canada
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Hassan MG, Alotaibi AM, Altuwaym RH, Alnuwaysir RH, Alharbi RB, Alnajashi LM, Alsaber MK, Aldakan HF, Hawesa HM, Abdelgabar ZA, Aldahes AS, Yaqob MG. Impact of Breathing Control Training Program on sonographic quantification of abdominal vasculature. Saudi Med J 2024; 45:525-530. [PMID: 38734441 PMCID: PMC11147564 DOI: 10.15537/smj.2024.45.5.20240083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Accepted: 04/23/2024] [Indexed: 05/13/2024] Open
Abstract
OBJECTIVES To compare vascular scanning parameters (vessel diameter, peak systolic velocity, end-diastolic velocity, and resistive index) and scanning time before and after breathing control training program for selected abdominal vessels. METHODS This study was pre and post quasi-experimental. The researchers designed a breathing training program that gives participants instructions through a video describing breathing maneuvers. Data were collected at the ultrasound laboratory/College of Health and Rehabilitation Sciences in Princess Nourah bint Abdul Rahman University, Riyadh, Saudi Arabia from January 2023 to November 2023. About 49 volunteers at the university participated in the study. Scanning was performed two times for the right renal artery, upper abdominal aorta, inferior vena cava, and superior mesenteric artery. Scanning time was measured before and after the program as well. A paired sample t-test was used to compare the parameters means and time before and after the program. RESULTS The program had a significant effect on the following parameters: right renal artery peak systolic velocity (p=0.042), upper abdominal aortic peak systolic velocity, and resistive index (p=0.014, p=0.014 respectively), superior mesenteric artery and inferior vena cava diameters (p=0.010 and p=0.020). The scanning time was reduced significantly (p<0.001). CONCLUSION The breathing training program saves time and improves ultrasound measurement quality. Hospitals and health centers should consider the importance of breathing control training programs before abdominal scanning.
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Affiliation(s)
- Mahasin G. Hassan
- From the Department of Radiological Sciences (Hassan, Alotaibi, Altuwaym, Alnuwaysir, Alharbi, Alnajashi, Alsaber, Aldakan, Hawesa, Aldahes), College of Health and Rehabilitation Sciences, Princess Nourah bint Abdulrahman University; from Software Development Department (Yaqob), N24 Company Limited, Riyadh; and from the Department of Radiological Sciences (Abdelgabar), Al-Ghad International Colleges for Applied Sciences, Madina, Kingdom of Saudi Arabia.
| | - Afnan M. Alotaibi
- From the Department of Radiological Sciences (Hassan, Alotaibi, Altuwaym, Alnuwaysir, Alharbi, Alnajashi, Alsaber, Aldakan, Hawesa, Aldahes), College of Health and Rehabilitation Sciences, Princess Nourah bint Abdulrahman University; from Software Development Department (Yaqob), N24 Company Limited, Riyadh; and from the Department of Radiological Sciences (Abdelgabar), Al-Ghad International Colleges for Applied Sciences, Madina, Kingdom of Saudi Arabia.
| | - Raghad H. Altuwaym
- From the Department of Radiological Sciences (Hassan, Alotaibi, Altuwaym, Alnuwaysir, Alharbi, Alnajashi, Alsaber, Aldakan, Hawesa, Aldahes), College of Health and Rehabilitation Sciences, Princess Nourah bint Abdulrahman University; from Software Development Department (Yaqob), N24 Company Limited, Riyadh; and from the Department of Radiological Sciences (Abdelgabar), Al-Ghad International Colleges for Applied Sciences, Madina, Kingdom of Saudi Arabia.
| | - Reem H. Alnuwaysir
- From the Department of Radiological Sciences (Hassan, Alotaibi, Altuwaym, Alnuwaysir, Alharbi, Alnajashi, Alsaber, Aldakan, Hawesa, Aldahes), College of Health and Rehabilitation Sciences, Princess Nourah bint Abdulrahman University; from Software Development Department (Yaqob), N24 Company Limited, Riyadh; and from the Department of Radiological Sciences (Abdelgabar), Al-Ghad International Colleges for Applied Sciences, Madina, Kingdom of Saudi Arabia.
| | - Renad B. Alharbi
- From the Department of Radiological Sciences (Hassan, Alotaibi, Altuwaym, Alnuwaysir, Alharbi, Alnajashi, Alsaber, Aldakan, Hawesa, Aldahes), College of Health and Rehabilitation Sciences, Princess Nourah bint Abdulrahman University; from Software Development Department (Yaqob), N24 Company Limited, Riyadh; and from the Department of Radiological Sciences (Abdelgabar), Al-Ghad International Colleges for Applied Sciences, Madina, Kingdom of Saudi Arabia.
| | - Lama M. Alnajashi
- From the Department of Radiological Sciences (Hassan, Alotaibi, Altuwaym, Alnuwaysir, Alharbi, Alnajashi, Alsaber, Aldakan, Hawesa, Aldahes), College of Health and Rehabilitation Sciences, Princess Nourah bint Abdulrahman University; from Software Development Department (Yaqob), N24 Company Limited, Riyadh; and from the Department of Radiological Sciences (Abdelgabar), Al-Ghad International Colleges for Applied Sciences, Madina, Kingdom of Saudi Arabia.
| | - Mayer K. Alsaber
- From the Department of Radiological Sciences (Hassan, Alotaibi, Altuwaym, Alnuwaysir, Alharbi, Alnajashi, Alsaber, Aldakan, Hawesa, Aldahes), College of Health and Rehabilitation Sciences, Princess Nourah bint Abdulrahman University; from Software Development Department (Yaqob), N24 Company Limited, Riyadh; and from the Department of Radiological Sciences (Abdelgabar), Al-Ghad International Colleges for Applied Sciences, Madina, Kingdom of Saudi Arabia.
| | - Hetaf F. Aldakan
- From the Department of Radiological Sciences (Hassan, Alotaibi, Altuwaym, Alnuwaysir, Alharbi, Alnajashi, Alsaber, Aldakan, Hawesa, Aldahes), College of Health and Rehabilitation Sciences, Princess Nourah bint Abdulrahman University; from Software Development Department (Yaqob), N24 Company Limited, Riyadh; and from the Department of Radiological Sciences (Abdelgabar), Al-Ghad International Colleges for Applied Sciences, Madina, Kingdom of Saudi Arabia.
| | - Halima M. Hawesa
- From the Department of Radiological Sciences (Hassan, Alotaibi, Altuwaym, Alnuwaysir, Alharbi, Alnajashi, Alsaber, Aldakan, Hawesa, Aldahes), College of Health and Rehabilitation Sciences, Princess Nourah bint Abdulrahman University; from Software Development Department (Yaqob), N24 Company Limited, Riyadh; and from the Department of Radiological Sciences (Abdelgabar), Al-Ghad International Colleges for Applied Sciences, Madina, Kingdom of Saudi Arabia.
| | - Zohida A. Abdelgabar
- From the Department of Radiological Sciences (Hassan, Alotaibi, Altuwaym, Alnuwaysir, Alharbi, Alnajashi, Alsaber, Aldakan, Hawesa, Aldahes), College of Health and Rehabilitation Sciences, Princess Nourah bint Abdulrahman University; from Software Development Department (Yaqob), N24 Company Limited, Riyadh; and from the Department of Radiological Sciences (Abdelgabar), Al-Ghad International Colleges for Applied Sciences, Madina, Kingdom of Saudi Arabia.
| | - Asma S. Aldahes
- From the Department of Radiological Sciences (Hassan, Alotaibi, Altuwaym, Alnuwaysir, Alharbi, Alnajashi, Alsaber, Aldakan, Hawesa, Aldahes), College of Health and Rehabilitation Sciences, Princess Nourah bint Abdulrahman University; from Software Development Department (Yaqob), N24 Company Limited, Riyadh; and from the Department of Radiological Sciences (Abdelgabar), Al-Ghad International Colleges for Applied Sciences, Madina, Kingdom of Saudi Arabia.
| | - Mohammed G. Yaqob
- From the Department of Radiological Sciences (Hassan, Alotaibi, Altuwaym, Alnuwaysir, Alharbi, Alnajashi, Alsaber, Aldakan, Hawesa, Aldahes), College of Health and Rehabilitation Sciences, Princess Nourah bint Abdulrahman University; from Software Development Department (Yaqob), N24 Company Limited, Riyadh; and from the Department of Radiological Sciences (Abdelgabar), Al-Ghad International Colleges for Applied Sciences, Madina, Kingdom of Saudi Arabia.
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Zamzmi G, Hsu LY, Rajaraman S, Li W, Sachdev V, Antani S. Evaluation of an artificial intelligence-based system for echocardiographic estimation of right atrial pressure. Int J Cardiovasc Imaging 2023; 39:2437-2450. [PMID: 37682418 PMCID: PMC10692014 DOI: 10.1007/s10554-023-02941-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Accepted: 08/18/2023] [Indexed: 09/09/2023]
Abstract
Current noninvasive estimation of right atrial pressure (RAP) by inferior vena cava (IVC) measurement during echocardiography may have significant inter-rater variability due to different levels of observers' experience. Therefore, there is a need to develop new approaches to decrease the variability of IVC analysis and RAP estimation. This study aims to develop a fully automated artificial intelligence (AI)-based system for automated IVC analysis and RAP estimation. We presented a multi-stage AI system to identify the IVC view, select good quality images, delineate the IVC region and quantify its thickness, enabling temporal tracking of its diameter and collapsibility changes. The automated system was trained and tested on expert manual IVC and RAP reference measurements obtained from 255 patients during routine clinical workflow. The performance was evaluated using Pearson correlation and Bland-Altman analysis for IVC values, as well as macro accuracy and chi-square test for RAP values. Our results show an excellent agreement (r=0.96) between automatically computed versus manually measured IVC values, and Bland-Altman analysis showed a small bias of [Formula: see text]0.33 mm. Further, there is an excellent agreement ([Formula: see text]) between automatically estimated versus manually derived RAP values with a macro accuracy of 0.85. The proposed AI-based system accurately quantified IVC diameter, collapsibility index, both are used for RAP estimation. This automated system could serve as a paradigm to perform IVC analysis in routine echocardiography and support various cardiac diagnostic applications.
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Affiliation(s)
- Ghada Zamzmi
- National Library of Medicine, National Institutes of Health, 8600 Rockville Pike, Bethesda, MD, 20894, USA
| | - Li-Yueh Hsu
- Clinical Center, National Institutes of Health, 10 Center Dr, Bethesda, MD, 20892, USA.
| | - Sivaramakrishnan Rajaraman
- National Library of Medicine, National Institutes of Health, 8600 Rockville Pike, Bethesda, MD, 20894, USA
| | - Wen Li
- National Heart, Lung, and Blood Institute, National Institutes of Health, 9000 Rockville Pike, Bethesda, MD, 20892, USA
| | - Vandana Sachdev
- National Heart, Lung, and Blood Institute, National Institutes of Health, 9000 Rockville Pike, Bethesda, MD, 20892, USA
| | - Sameer Antani
- National Library of Medicine, National Institutes of Health, 8600 Rockville Pike, Bethesda, MD, 20894, USA.
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8
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Octavius GS, Imanuelly M, Wibowo J, Heryadi NK, Widjaja M. Inferior vena cava to aorta ratio in dehydrated pediatric patients: a systematic review and meta-analysis. Clin Exp Pediatr 2023; 66:477-484. [PMID: 37321576 PMCID: PMC10626024 DOI: 10.3345/cep.2022.01445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 01/31/2023] [Accepted: 02/06/2023] [Indexed: 06/17/2023] Open
Abstract
BACKGROUND Dehydration due to acute diarrhea is among the leading causes of mortality. However, advancements in management and technology do not help clinicians differentiate dehydration degrees. Ultrasound using the inferior vena cava to aorta (IVC/ Ao) ratio is a promising noninvasive technique to identify significant pediatric dehydration. PUSPOSE Therefore, this systematic review and meta-analysis aimed to examine the diagnostic parameters of the IVC/Ao ratio for predicting clinically significant dehydration in pediatric patients. METHODS We searched the MEDLINE, PubMed, Cochrane Library, ScienceDirect, and Google Scholar databases for studies of pediatric patients (≤18 years old) who presented with signs and symptoms of dehydration due to acute diarrhea, gastroenteritis, or vomiting. The inclusion criteria were cross-sectional, case-control, cohort, and randomized controlled trial study design and publication in any language. We then conducted a meta-analysis using the midas and metandi commands from Stata software. RESULTS Five studies of 461 patients were included. The combined sensitivity was 86% (95% confidence interval [CI], 79%-91%), while the specificity was 73% (95% CI, 59%-84%). The area under the curve was 0.89 (95% CI, 0.86-0.91). The positive likelihood ratio (LR+) was 3.2 (95% CI, 2.1-5.1) with a 76% posttest probability, while the negative likelihood ratio (LR-) was 0.18 (95% CI, 0.12-0.28) with a 16% posttest probability. The combined negative predictive value was 0.83 (95% CI, 0.75-0.91), while the positive predictive value was 0.75 (95% CI, 0.68-0.82). CONCLUSION The IVC/Ao ratio was insufficient to exclude or confirm significant dehydration in pediatric patients. More studies are needed, especially multicenter, adequately powered diagnostic research, to will help establish the usefulness of the IVC/Ao ratio.
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Affiliation(s)
| | - Michelle Imanuelly
- Department of Pediatrics, Universitas Pelita Harapan, Jakarta, Indonesia
| | - Johan Wibowo
- Department of Pediatrics, Universitas Pelita Harapan, Jakarta, Indonesia
| | | | - Melanie Widjaja
- Department of Pediatrics, Universitas Pelita Harapan, Jakarta, Indonesia
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9
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Kaptein EM, Kaptein MJ. Inferior vena cava ultrasound and other techniques for assessment of intravascular and extravascular volume: an update. Clin Kidney J 2023; 16:1861-1877. [PMID: 37915939 PMCID: PMC10616489 DOI: 10.1093/ckj/sfad156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Indexed: 11/03/2023] Open
Abstract
Goals of volume management are to accurately assess intravascular and extravascular volume and predict response to volume administration, vasopressor support or volume removal. Data are reviewed that support the following: (i) Dynamic parameters reliably guide volume administration and may improve clinical outcomes compared with static parameters, but some are invasive or only validated with mechanical ventilation without spontaneous breathing. (ii) Ultrasound visualization of inferior vena cava (IVC) diameter variations with respiration reliably assesses intravascular volume and predicts volume responsiveness. (iii) Although physiology of IVC respiratory variations differs with mechanical ventilation and spontaneous breathing, the IVC collapsibility index (CI) and distensibility index are interconvertible. (iv) Prediction of volume responsiveness by IVC CI is comparable for mechanical ventilation and spontaneous breathing patients. (v) Respiratory variations of subclavian/proximal axillary and internal jugular veins by ultrasound are alternative sites, with comparable reliability. (vi) Data support clinical applicability of IVC CI to predict hypotension with anesthesia, guide ultrafiltration goals, predict dry weight, predict intra-dialytic hypotension and assess acute decompensated heart failure. (vii) IVC ultrasound may complement ultrasound of heart and lungs, and abdominal organs for venous congestion, for assessing and managing volume overload and deresuscitation, renal failure and shock. (viii) IVC ultrasound has limitations including inadequate visualization. Ultrasound data should always be interpreted in clinical context. Additional studies are required to further assess and validate the role of bedside ultrasonography in clinical care.
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Affiliation(s)
- Elaine M Kaptein
- Departments of Medicine, Divisions of Nephrology, University of Southern California, Los Angeles, CA, USA
| | - Matthew J Kaptein
- Departments of Medicine, Divisions of Nephrology, University of Southern California, Los Angeles, CA, USA
- Loma Linda University Medical Center, Loma Linda, CA, USA
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10
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Koc Güdük N, Sahin T. Follow-up of perfusion index and inferior vena cava collapsibility index in fluid therapy in prerenal acute renal failure. Heliyon 2023; 9:e18715. [PMID: 37576286 PMCID: PMC10415656 DOI: 10.1016/j.heliyon.2023.e18715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 07/08/2023] [Accepted: 07/25/2023] [Indexed: 08/15/2023] Open
Abstract
Introduction Acute renal failure (ARF), which may occur as a result of hypovolemia, is frequently diagnosed in emergency departments. It is essential to determine these patients' volume status and fluid requirement. The aim of this study was to examine the change in the inferior vena cava (IVC) collapsibility index and perfusion index (PI) in order to evaluate fluid deficit, volume status, and response to fluid therapy in patients with prerenal ARF who presented with signs of hypovolemia. Materials and methods The study sample included 104 patients diagnosed with prerenal ARF due to hypovolemia in our emergency department. After obtaining informed consent from the patients, intravenous (IV) fluid therapy (20 cc/kg IV infusion of 0.9% sodium chloride solution for 30 min) was initiated. The PI and IVC collapsibility index were measured before and after the treatment. Results Of the patients included in this study, 56.7% were women. The mean age was 76.06 years. Of the patients, 46.2% had a history of multiple diseases. Avoidant/restrictive food intake disorder was the most common complaint (28.8%). The mean PI of the patients was 2.20 at admission, which increased to 3.27 after treatment. The mean IVC collapsibility index was 38.39 at admission, which decreased to 29.36 after treatment. There was a significant and negative correlation between the PI and IVC collapsibility index of the patients. Conclusions Early diagnosis and treatment of ARF in emergency departments are critical. Serial measurements of the IVC collapsibility index and PI are helpful in monitoring patients' response to fluid therapy.
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Affiliation(s)
| | - Taner Sahin
- Emergency Medicine Department Kayseri City Training and Research Hospital Affiliated with University of Health Sciences Turkey, Kayseri, Turkey
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11
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Bourel C, Durand A, Ter Schiphorst B, Martin C, Onimus T, De Jonckheere J, Howsam M, Pierre A, Favory R, Preau S. RESPIRATION-RELATED VARIATIONS IN CENTRAL VENOUS PRESSURE AS PREDICTORS OF FLUID RESPONSIVENESS IN SPONTANEOUSLY BREATHING PATIENTS. Shock 2023; 60:190-198. [PMID: 37548683 DOI: 10.1097/shk.0000000000002164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/08/2023]
Abstract
ABSTRACT Objective : The hemodynamic parameters used to accurately predict fluid responsiveness (FR) in spontaneously breathing patients (SB) require specific material and expertise. Measurements of the central venous pressure (CVP) are relatively simple and, importantly, are feasible in many critically ill patients. We analyzed the accuracy of respiration-related variations in CVP (vCVP) to predict FR in SB patients and examined the optimization of its measurement using a standardized, deep inspiratory maneuver. Patients and Methods : We performed a monocentric, prospective, diagnostic evaluation. Spontaneously breathing patients in intensive care units with a central venous catheter were prospectively included. The vCVP was measured while the patient was spontaneously breathing, both with (vCVP-st) and without (vCVP-ns) a standardized inspiratory maneuver, and calculated as: Minimum inspiratory v-wave peak pressure - Maximum expiratory v-wave peak pressure. A passive leg raising-induced increase in the left ventricular outflow tract velocity-time integral ≥10% defined FR. Results : Among 63 patients, 38 (60.3%) presented FR. The vCVP-ns was not significantly different between responders and nonresponders (-4.9 mm Hg [-7.5 to -3.1] vs. -4.1 mm Hg [-5.4 to 2.8], respectively; P = 0.15). The vCVP-st was lower in responders than nonresponders (-9.7 mm Hg [-13.9 to -6.2] vs. -3.6 mm Hg [-10.6 to -1.6], respectively; P = 0.004). A vCVP-st < -4.7 mm Hg predicted FR with 89.5% sensitivity, a specificity of 56.0%, and an area under the receiver operating characteristic curve of 0.72 (95% CI, 0.58 to 0.86) ( P = 0.004). Conclusion : When a central venous catheter is present, elevated values for vCVP-st may be useful to identify spontaneously breathing patients unresponsive to volume expansion. Nevertheless, the necessity of performing a standardized, deep-inspiration maneuver may limit its clinical application.
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Affiliation(s)
- Claire Bourel
- Medical Intensive Care Unit, CHU Lille, Univ. Lille, Lille, France
| | - Arthur Durand
- Medical Intensive Care Unit, CHU Lille, Univ. Lille, Lille, France
| | | | - Claire Martin
- CHU Lille, Department of Biostatistics, Lille, France
| | - Thierry Onimus
- Medical Intensive Care Unit, CHU Lille, Univ. Lille, Lille, France
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Pranskunas A, Gulbinaite E, Navickaite A, Pranskuniene Z. Differences in Hemodynamic Response to Passive Leg Raising Tests during the Day in Healthy Individuals: The Question of Normovolemia. Life (Basel) 2023; 13:1606. [PMID: 37511981 PMCID: PMC10381249 DOI: 10.3390/life13071606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 07/06/2023] [Accepted: 07/18/2023] [Indexed: 07/30/2023] Open
Abstract
BACKGROUND The passive leg-raising (PLR) test was developed to predict fluid responsiveness and reduce fluid overload. However, the hemodynamic response of healthy individuals to the PLR test and how it changes during the day, between the morning and evening, after individuals have consumed food and fluids, has not been profoundly explored. This study aimed to compare the systemic hemodynamic changes in healthy individuals between morning and evening PLR tests. METHODS In this study, the PLR test was performed twice a day. The first PLR test was performed between 08h00 and 09h00 in the morning, while the second PLR test was performed between 20h00 and 21h00 in the evening. Hemodynamic parameters were measured using an impedance cardiography monitor, and a cutoff value of a 10% increase in stroke volume (SV) during the PLR test was used to differentiate between preload responders and non-responders. RESULTS We included 50 healthy volunteers in this study. When comparing the morning and evening PLR test results, we found no PLR-induced differences in heart rate (-3 [-8-2] vs. -2 [-8-4] beats/min, p = 0.870), SV (11 [5-22] vs. 12 [4-20] mL, p = 0.853) or cardiac output (0.7 [0.2-1.3] vs. 0.8 [0.1-1.4] L/min, p = 0.639). We also observed no differences in the proportion of preload responders during the PLR test between the morning and evening (64% vs. 66%, p = 0.99). However, there was a moderate agreement between the two PLR tests (morning and evening) (kappa = 0.429, p = 0.012). There was a moderate correlation between the changes in SV between the two PLR tests (rs = 0.50, p < 0.001). CONCLUSION In young, healthy individuals, we observed no change in the systemic hemodynamic responsiveness to the PLR test between the morning and evening, without restriction of fluid and food intake.
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Affiliation(s)
- Andrius Pranskunas
- Department of Intensive Care Medicine, Lithuanian University of Health Sciences, Eiveniu g. 2, 50161 Kaunas, Lithuania
| | - Egle Gulbinaite
- Faculty of Medicine, Medical Academy, Lithuanian University of Health Sciences, A. Mickeviciaus g. 9, 44307 Kaunas, Lithuania
| | - Aiste Navickaite
- Faculty of Medicine, Medical Academy, Lithuanian University of Health Sciences, A. Mickeviciaus g. 9, 44307 Kaunas, Lithuania
| | - Zivile Pranskuniene
- Institute of Pharmaceutical Technologies, Lithuanian University of Health Sciences, Sukileliu pr. 13, 50166 Kaunas, Lithuania
- Department of Drug Technology and Social Pharmacy, Lithuanian University of Health Sciences, Sukileliu pr. 13, 50166 Kaunas, Lithuania
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13
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Oh AR, Lee JH. Predictors of fluid responsiveness in the operating room: a narrative review. Anesth Pain Med (Seoul) 2023; 18:233-243. [PMID: 37468195 PMCID: PMC10410540 DOI: 10.17085/apm.23072] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 07/13/2023] [Accepted: 07/14/2023] [Indexed: 07/21/2023] Open
Abstract
Prediction of fluid responsiveness has been considered an essential tool for modern fluid management. However, most studies in this field have focused on patients in intensive care unit despite numerous research throughout several decades. Therefore, the present narrative review aims to show the representative method's feasibility, advantages, and limitations in predicting fluid responsiveness, focusing on the operating room environments. Firstly, we described the predictors of fluid responsiveness based on heart-lung interaction, including pulse pressure and stroke volume variations, the measurement of respiratory variations of inferior vena cava diameter, and the end-expiratory occlusion test and addressed their limitations. Subsequently, the passive leg raising test and mini-fluid challenge tests were also mentioned, which assess fluid responsiveness by mimicking a classic fluid challenge. In the last part of this review, we pointed out the pitfalls of fluid management based on fluid responsiveness prediction, which emphasized the importance of individualized decision-making. Understanding the available representative methods to predict fluid responsiveness and their associated benefits and drawbacks through this review will aid anesthesiologists in choosing the most reliable methods for optimal fluid administration in each patient during anesthesia in the operating room.
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Affiliation(s)
- Ah Ran Oh
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Seoul, Korea
| | - Jong-Hwan Lee
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Seoul, Korea
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14
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Spiliotaki E, Saranteas T, Moschovaki N, Panagouli K, Pistioli E, Kitsinelis V, Briasoulis P, Papadimos T. Inferior vena cava ultrasonography in the assessment of intravascular volume status and fluid responsiveness in the emergency department and intensive care unit: A critical analysis review. JOURNAL OF CLINICAL ULTRASOUND : JCU 2022; 50:733-744. [PMID: 35302241 DOI: 10.1002/jcu.23194] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 02/23/2022] [Accepted: 03/09/2022] [Indexed: 06/14/2023]
Abstract
Rapid evaluation of intravascular volume status is vital; either excessive or limited fluid administration may result in adverse patient outcomes. In this narrative review, critical analysis of pertinent diagnostic accuracy studies is developed to delineate the role of inferior vena cava ultrasound measurements in the assessment of both intravascular volume status and fluid responsiveness in the emergency department and intensive care unit. In addition, limitations, and technical considerations of inferior vena cava ultrasound measurements as well as directions for future research are thoroughly discussed.
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Affiliation(s)
- Eleni Spiliotaki
- Department of Anesthesiology, National and Kapodistrian University of Athens, Athens, Greece
| | - Theodosios Saranteas
- Department of Anesthesiology, National and Kapodistrian University of Athens, Athens, Greece
- Department of Anesthesia, Division of critical care, Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Nefeli Moschovaki
- Department of Anesthesiology, National and Kapodistrian University of Athens, Athens, Greece
| | - Konstantina Panagouli
- Department of Anesthesiology, National and Kapodistrian University of Athens, Athens, Greece
| | - Efstathia Pistioli
- Department of Anesthesiology, National and Kapodistrian University of Athens, Athens, Greece
| | - Vasilios Kitsinelis
- Department of Cardiology, National and Kapodistrian University of Athens, Athens, Greece
| | - Panagiotis Briasoulis
- Department of Anesthesiology, National and Kapodistrian University of Athens, Athens, Greece
| | - Thomas Papadimos
- Department of Anesthesia, Division of critical care, Ohio State University Wexner Medical Center, Columbus, Ohio, USA
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Monnet X, Shi R, Teboul JL. Prediction of fluid responsiveness. What’s new? Ann Intensive Care 2022; 12:46. [PMID: 35633423 PMCID: PMC9148319 DOI: 10.1186/s13613-022-01022-8] [Citation(s) in RCA: 91] [Impact Index Per Article: 30.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 05/09/2022] [Indexed: 02/07/2023] Open
Abstract
AbstractAlthough the administration of fluid is the first treatment considered in almost all cases of circulatory failure, this therapeutic option poses two essential problems: the increase in cardiac output induced by a bolus of fluid is inconstant, and the deleterious effects of fluid overload are now clearly demonstrated. This is why many tests and indices have been developed to detect preload dependence and predict fluid responsiveness. In this review, we take stock of the data published in the field over the past three years. Regarding the passive leg raising test, we detail the different stroke volume surrogates that have recently been described to measure its effects using minimally invasive and easily accessible methods. We review the limits of the test, especially in patients with intra-abdominal hypertension. Regarding the end-expiratory occlusion test, we also present recent investigations that have sought to measure its effects without an invasive measurement of cardiac output. Although the limits of interpretation of the respiratory variation of pulse pressure and of the diameter of the vena cava during mechanical ventilation are now well known, several recent studies have shown how changes in pulse pressure variation itself during other tests reflect simultaneous changes in cardiac output, allowing these tests to be carried out without its direct measurement. This is particularly the case during the tidal volume challenge, a relatively recent test whose reliability is increasingly well established. The mini-fluid challenge has the advantage of being easy to perform, but it requires direct measurement of cardiac output, like the classic fluid challenge. Initially described with echocardiography, recent studies have investigated other means of judging its effects. We highlight the problem of their precision, which is necessary to evidence small changes in cardiac output. Finally, we point out other tests that have appeared more recently, such as the Trendelenburg manoeuvre, a potentially interesting alternative for patients in the prone position.
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16
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Suehiro K. Assessing fluid responsiveness during spontaneous breathing. J Anesth 2022; 36:579-582. [PMID: 35606608 DOI: 10.1007/s00540-022-03075-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Accepted: 05/04/2022] [Indexed: 11/26/2022]
Affiliation(s)
- Koichi Suehiro
- Department of Anesthesiology, Osaka Metropolitan University Graduate School of Medicine, 1-5-7 Asahimachi, Abenoku, Osaka City, Osaka, 545-8586, Japan.
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17
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Aissaoui Y, Jozwiak M, Bahi M, Belhadj A, Alaoui H, Qamous Y, Serghini I, Seddiki R. Prediction of post-induction hypotension by point-of-care echocardiography: A prospective observational study. Anaesth Crit Care Pain Med 2022; 41:101090. [PMID: 35508291 DOI: 10.1016/j.accpm.2022.101090] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 02/23/2022] [Accepted: 03/03/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND Post-induction hypotension (PIH) is a common side effect of general anaesthesia and is associated with poor perioperative outcomes. We assessed the ability of two point-of-care echocardiographic variables to predict the occurrence of PIH: the passive leg raising-induced changes in the velocity-time integral of the left ventricular outflow tract (ΔVTI-PLR) and the inferior vena cava collapsibility index (IVC-CI). METHODS We studied 64 patients > 50 years scheduled for elective abdominal surgery. ΔVTI-PLR and IVC-CI were prospectively obtained before general anaesthesia induction. PIH was defined by a systolic arterial pressure < 90 mmHg or a mean arterial pressure < 65 mmHg or by a decrease in systolic or mean arterial pressure > 30% from pre-induction level. Intraclass correlation coefficients (ICCs) were calculated to assess the reproducibility of echocardiographic measurements. Receiver operating characteristic (ROC) curves with 95% confidence intervals (CIs) were generated to test the ability of ΔVTI-PLR and IVC-CI to predict the occurrence of PIH. RESULTS PIH occurred in 33 (51%) patients. The ICCs for VTI and IVC measurements showed excellent reproducibility. The occurrence of PIH was accurately predicted by ΔVTI-PLR with an area under the ROC curve (AUROC) of 0.89 (95% CI: 0.80-0.97), a threshold value of 18% with a sensitivity of 88% (95% CI: 71-97%) and a specificity of 84% (95% CI: 66-94%). The occurrence of PIH was poorly predicted by IVC-CI with an AUROC of 0.68 (95% CI: 0.54-0.80) and a threshold value of 42%. CONCLUSIONS ΔVTI-PLR, unlike IVC-CI, could reliably predict the occurrence of PIH. The use of ΔVTI-PLR could help individualise anaesthesia management to prevent PIH.
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Affiliation(s)
- Younes Aissaoui
- Pôle Anesthésie Réanimation, Hôpital Militaire Avicenne, 1 Avenue Al Mouqaouama, 40015, Marrakesh, Morocco; Laboratoire Biosciences et Santé, Faculté de Médecine et de Pharmacie, Université Cadi Ayyad, 40000, Marrakesh, Morocco.
| | - Mathieu Jozwiak
- Service de Médecine Intensive Réanimation, Centre Hospitalier Universitaire de Nice, Hôpital l'Archet 1, 151 route saint Antoine de Ginestière, 06200, Nice, France; UR2CA, Unité de Recherche Clinique Côte d'Azur, Université Côte d'Azur, Nice, France
| | - Mohammed Bahi
- Pôle Anesthésie Réanimation, Hôpital Militaire Avicenne, 1 Avenue Al Mouqaouama, 40015, Marrakesh, Morocco
| | - Ayoub Belhadj
- Pôle Anesthésie Réanimation, Hôpital Militaire Avicenne, 1 Avenue Al Mouqaouama, 40015, Marrakesh, Morocco; Laboratoire Biosciences et Santé, Faculté de Médecine et de Pharmacie, Université Cadi Ayyad, 40000, Marrakesh, Morocco
| | - Hassan Alaoui
- Pôle Anesthésie Réanimation, Hôpital Militaire Avicenne, 1 Avenue Al Mouqaouama, 40015, Marrakesh, Morocco; Laboratoire Biosciences et Santé, Faculté de Médecine et de Pharmacie, Université Cadi Ayyad, 40000, Marrakesh, Morocco
| | - Youssef Qamous
- Pôle Anesthésie Réanimation, Hôpital Militaire Avicenne, 1 Avenue Al Mouqaouama, 40015, Marrakesh, Morocco; Laboratoire Biosciences et Santé, Faculté de Médecine et de Pharmacie, Université Cadi Ayyad, 40000, Marrakesh, Morocco
| | - Issam Serghini
- Pôle Anesthésie Réanimation, Hôpital Militaire Avicenne, 1 Avenue Al Mouqaouama, 40015, Marrakesh, Morocco; Laboratoire Biosciences et Santé, Faculté de Médecine et de Pharmacie, Université Cadi Ayyad, 40000, Marrakesh, Morocco
| | - Rachid Seddiki
- Pôle Anesthésie Réanimation, Hôpital Militaire Avicenne, 1 Avenue Al Mouqaouama, 40015, Marrakesh, Morocco; Laboratoire Biosciences et Santé, Faculté de Médecine et de Pharmacie, Université Cadi Ayyad, 40000, Marrakesh, Morocco
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Ruge M, Marhefka GD. IVC measurement for the noninvasive evaluation of central venous pressure. J Echocardiogr 2022; 20:133-143. [PMID: 35362870 DOI: 10.1007/s12574-022-00569-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 02/07/2022] [Accepted: 03/16/2022] [Indexed: 01/19/2023]
Abstract
Central venous pressure (CVP) is one of only a handful of variables that can be used to assess a patient's volume status to attempt to optimize stroke volume. The gold standard method for assessing CVP is though pulmonary artery catheterization, which is invasive and risks severe complications such as pneumothorax and cardiac conduction abnormalities. Current noninvasive methods for estimating CVP such as jugular venous pressure assessment are imperfect with wide inter-examiner variability. The inferior vena cava (IVC) is a highly compliant vessel that uniquely does not constrict in response to hypovolemia, making it an ideal, noninvasive surrogate for the estimation of CVP. A range of IVC indices including minimum and maximum IVC diameter and fraction of IVC collapse with inspiration (known as collapsibility index) have been studied with highly variable results that range from excellent to poor correlation between these values and CVP. Despite this inconsistency in findings, multiple schemes have been proposed to attempt to estimate CVP from IVC measurements, but when prospectively tested, none has been shown to be accurate. Since the most recent 2015 American Society of Echocardiography guidelines, multiple studies have identified unique ways of improving the accuracy of IVC measurement, which could translate into better CVP estimation. The goal of this review is to summarize the many, often conflicting studies that exist in this area, and provide recommendations for future studies based on our findings.
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Affiliation(s)
- Max Ruge
- Department of Internal Medicine, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Gregary D Marhefka
- Division of Cardiology, Thomas Jefferson University Hospital, Jefferson Heart Institute, 925 Chestnut Street, Philadelphia, PA, 19107, USA.
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Lau YH, See KC. Point-of-care ultrasound for critically-ill patients: A mini-review of key diagnostic features and protocols. World J Crit Care Med 2022; 11:70-84. [PMID: 35433316 PMCID: PMC8968483 DOI: 10.5492/wjccm.v11.i2.70] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Revised: 12/08/2021] [Accepted: 02/10/2022] [Indexed: 02/06/2023] Open
Abstract
Point-of-care ultrasonography (POCUS) for managing critically ill patients is increasingly performed by intensivists or emergency physicians. Results of needs surveys among intensivists reveal emphasis on basic cardiac, lung and abdominal ultrasound, which are the commonest POCUS modalities in the intensive care unit. We therefore aim to describe the key diagnostic features of basic cardiac, lung and abdominal ultrasound as practised by intensivists or emergency physicians in terms of accuracy (sensitivity, specificity), clinical utility and limitations. We also aim to explore POCUS protocols that integrate basic cardiac, lung and abdominal ultrasound, and highlight areas for future research.
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Affiliation(s)
- Yie Hui Lau
- Department of Anaesthesiology, Intensive Care and Pain Medicine, Tan Tock Seng Hospital, Singapore 308433, Singapore
| | - Kay Choong See
- Division of Respiratory & Critical Care Medicine, National University Hospital, Singapore 119074, Singapore
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Xiong Z, Zhang G, Zhou Q, Lu B, Zheng X, Wu M, Qu Y. Predictive Value of the Respiratory Variation in Inferior Vena Cava Diameter for Ventilated Children With Septic Shock. Front Pediatr 2022; 10:895651. [PMID: 35874570 PMCID: PMC9301070 DOI: 10.3389/fped.2022.895651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 05/25/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES This study aimed to investigate the predictive utility of respiratory variations of inferior vena cava diameters on fluid responsiveness in children with septic shock. DESIGN A prospective observational single-center study. SETTING A pediatric intensive care unit in a tertiary hospital in China. PARTICIPANTS Patients with sepsis shock who require invasive mechanical ventilation were recruited between 1 December 2017 and 1 November 2021. INTERVENTIONS AND MEASUREMENTS Volume expansion (VE) was induced by a 30-min infusion of 20 ml/kg of normal saline. Hemodynamics indexes were obtained through bedside transthoracic echocardiography (TTE) measurement and calculation. RESULTS A total of 86 patients were enrolled in this study, among them, 45 patients (52.3%) were considered to be non-responders (NR), with an increase in stroke volume variation (SVV) <15% after VE. Multivariate logistic analysis showed that ΔIVC (adjusted OR = 1.615, 95% CI 1.092-2.215, p = 0.012) was the significant predictor associated with the fluid responsiveness. The area under the ROC of ΔIVC was 0.922 (95% CI: 0.829-1.000, p < 0.01), and the cutoff value of ΔIVC used to predict fluid responsiveness was 28.5%, with a sensitivity and specificity of 95.4 and 68.5%, respectively. CONCLUSIONS The ΔIVC was found to have a potential value in predicting fluid responsiveness in mechanically ventilated children with septic shock.
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Affiliation(s)
- Zihong Xiong
- Department of Pediatrics/Key Laboratory of Birth Defects and Related Diseases of Women and Children (Ministry of Education), West China Second University Hospital, Sichuan University, Chengdu, China.,Department of Pediatric Intensive Care Unit, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Guoying Zhang
- Department of Pediatric Intensive Care Unit, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Qin Zhou
- Department of Pediatric Intensive Care Unit, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Bing Lu
- Department of Pediatric Intensive Care Unit, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Xuemei Zheng
- School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Mengjun Wu
- Department of Anesthesiology, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Yi Qu
- Department of Pediatrics/Key Laboratory of Birth Defects and Related Diseases of Women and Children (Ministry of Education), West China Second University Hospital, Sichuan University, Chengdu, China
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Kim DW, Chung S, Kang WS, Kim J. Diagnostic Accuracy of Ultrasonographic Respiratory Variation in the Inferior Vena Cava, Subclavian Vein, Internal Jugular Vein, and Femoral Vein Diameter to Predict Fluid Responsiveness: A Systematic Review and Meta-Analysis. Diagnostics (Basel) 2021; 12:diagnostics12010049. [PMID: 35054215 PMCID: PMC8774961 DOI: 10.3390/diagnostics12010049] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 12/22/2021] [Accepted: 12/22/2021] [Indexed: 01/08/2023] Open
Abstract
This systematic review and meta-analysis aimed to investigate the ultrasonographic variation of the diameter of the inferior vena cava (IVC), internal jugular vein (IJV), subclavian vein (SCV), and femoral vein (FV) to predict fluid responsiveness in critically ill patients. Relevant articles were obtained by searching PubMed, EMBASE, and Cochrane databases (articles up to 21 October 2021). The number of true positives, false positives, false negatives, and true negatives for the index test to predict fluid responsiveness was collected. We used a hierarchical summary receiver operating characteristics model and bivariate model for meta-analysis. Finally, 30 studies comprising 1719 patients were included in this review. The ultrasonographic variation of the IVC showed a pooled sensitivity and specificity of 0.75 and 0.83, respectively. The area under the receiver operating characteristics curve was 0.86. In the subgroup analysis, there was no difference between patients on mechanical ventilation and those breathing spontaneously. In terms of the IJV, SCV, and FV, meta-analysis was not conducted due to the limited number of studies. The ultrasonographic measurement of the variation in diameter of the IVC has a favorable diagnostic accuracy for predicting fluid responsiveness in critically ill patients. However, there was insufficient evidence in terms of the IJV, SCV, and FV.
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Affiliation(s)
- Do-Wan Kim
- Department of Thoracic and Cardiovascular Surgery, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju 61469, Korea;
| | - Seungwoo Chung
- Department of Critical Care Medicine, Gyeongsang National University Changwon Hospital, Changwon 51472, Korea;
| | - Wu-Seong Kang
- Department of Trauma Surgery, Jeju Regional Trauma Center, Cheju Halla General Hospital, Jeju 63127, Korea;
- Correspondence:
| | - Joongsuck Kim
- Department of Trauma Surgery, Jeju Regional Trauma Center, Cheju Halla General Hospital, Jeju 63127, Korea;
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22
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Kaptein MJ, Kaptein EM. Inferior Vena Cava Collapsibility Index: Clinical Validation and Application for Assessment of Relative Intravascular Volume. Adv Chronic Kidney Dis 2021; 28:218-226. [PMID: 34906306 DOI: 10.1053/j.ackd.2021.02.003] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 01/21/2021] [Accepted: 02/02/2021] [Indexed: 12/23/2022]
Abstract
Accurate assessment of relative intravascular volume is critical to guide volume management of patients with acute or chronic kidney disorders, particularly those with complex comorbidities requiring hospitalization or intensive care. Inferior vena cava (IVC) diameter variability with respiration measured by ultrasound provides a dynamic noninvasive point-of-care estimate of relative intravascular volume. We present details of image acquisition, interpretation, and clinical scenarios to which IVC ultrasound can be applied. The variation in IVC diameter over the respiratory or ventilatory cycle is greater in patients who are volume responsive than those who are not volume responsive. When 2 recent prospective studies of spontaneously breathing patients (n = 214) are added to a prior meta-analysis of 181 patients, for a total of 7 studies of 395 spontaneously breathing patients, IVC collapsibility index (CI) had a pooled sensitivity of 71% and specificity of 81% for predicting volume responsiveness, which is similar to a pooled sensitivity of 75% and specificity of 82% for 9 studies of 284 mechanically ventilated patients. IVC maximum diameter <2.1 cm, that collapses >50% with or without a sniff is inconsistent with intravascular volume overload and suggests normal right atrial pressure (0-5 mmHg). Inferior vena cava collapsibility (IVC CI) < 20% with no sniff suggests increased right atrial pressure and is inconsistent with overt hypovolemia in spontaneously breathing or ventilated patients. These IVC CI cutoffs do not appear to vary greatly depending on whether patients are breathing spontaneously or are mechanically ventilated. Patients with lower IVC CI are more likely to tolerate ultrafiltration with hemodialysis or improve cardiac output with ultrafiltration. Our goal for IVC CI generally ranges from 20% to 50%, respecting potential biases to interpretation and overriding clinical considerations. IVC ultrasound may be limited by factors that affect IVC diameter or collapsibility, clinical interpretation, or optimal visualization, and must be interpreted in the context of the entire clinical situation.
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23
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Caplan M, Howsam M, Favory R, Preau S. Predicting fluid responsiveness in non-intubated COVID-19 patients: two methods are better than one. Ann Intensive Care 2021; 11:34. [PMID: 33590379 PMCID: PMC7883961 DOI: 10.1186/s13613-021-00826-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 02/06/2021] [Indexed: 11/13/2022] Open
Affiliation(s)
- Morgan Caplan
- Division of Intensive Care, University of Lille, CHU Lille, 59000, Lille, France
| | - Michael Howsam
- Inserm, Institut Pasteur de Lille, U1167, University of Lille, 59000, Lille, France
| | - Raphael Favory
- Division of Intensive Care, Inserm, Institut Pasteur de Lille, U1167, University of Lille, CHU Lille, 59000, Lille, France
| | - Sebastien Preau
- Division of Intensive Care, Inserm, Institut Pasteur de Lille, U1167, University of Lille, CHU Lille, 59000, Lille, France.
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24
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Michard F. Predicting fluid responsiveness in non-intubated COVID-19 patients. Ann Intensive Care 2021; 11:19. [PMID: 33502603 PMCID: PMC7839622 DOI: 10.1186/s13613-021-00813-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 01/18/2021] [Indexed: 12/18/2022] Open
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