Automated Inferior Vena Cava Distensibility Index for Assessing Fluid Responsiveness in Ventilated Patients After Cardiac Surgery: A Prospective Pilot Comparative Study.
Amr Salah Omar, Praveen C Sivadasan, Suraj Sudarsanan, Hany O Ragab, Alaa Rahhal, Samy Hanoura, Sameh Aboulnaga, Abdelrahman Abdalla, Abdulwahid Almulla
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Abstract
Objectives: This study aimed to assess the accuracy of inferior vena cava distensibility index (IVC-DI) measurements, as well as the ability to track fluid responsiveness (FR) over time.
Participants: Fifty consecutive after cardiac surgery.
Interventions: We compared (1) the automated echocardiographic method with (2) the stroke volume variation (SVV) technique and (3) the manual echocardiographic method.
Measurements: FR was measured simultaneously with all 3 methods in 50 patients after cardiac surgery. A second comparison was performed 90 to 180 minutes later. The outcomes assessed included the correlations between SVV with the automated IVC-DI and the manual IVC-DI, respectively, before and after fluid challenge, as well as the accuracy of FR according to the automated and manual IVC-DI. FR is defined as an increase in cardiac output by more than 10% after receiving a fluid challenge.
Results: A total of 50 patients who underwent cardiac surgery were included (age 51 ± 8 years; 86% males). Before the fluid challenge, a negative correlation between automated and manual IVC-DI was observed (r = -0.141; p = 0.328) with a concordance rate of 98%, although the correlation became positive after the fluid challenge (r = 0.172; p = 0.233) with a concordance rate of 98%. After fluid challenge, SVV correlation with automated IVC-DI and manual IVC-DI was positive, with the latter being statistically significant (r = 0.352; p = 0.012). FR predicted by automated IVC-DI was found to have a sensitivity of 64% and specificity 49% with a receiver operating characteristic area under the curve of 0.55.
Conclusions: Among cardiac surgical patients, manual IVC-DI correlated significantly with SVV in assessing FR. However, the automated IVC-DI mode demonstrated less reliability.
期刊介绍：
The Journal of Cardiothoracic and Vascular Anesthesia is primarily aimed at anesthesiologists who deal with patients undergoing cardiac, thoracic or vascular surgical procedures. JCVA features a multidisciplinary approach, with contributions from cardiac, vascular and thoracic surgeons, cardiologists, and other related specialists. Emphasis is placed on rapid publication of clinically relevant material.
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