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

Abstract

Aim: First, 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.

Methods: Pulse 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.

Results: Eighteen 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%.

Conclusion: DIVC is a reliable indicator of capacity responsiveness in mechanically ventilated post-pneumonectomy patients.

Keywords: inferior vena cava distensibility index; stroke volume variationinnuid; ultrasound; volume responsiveness.