Abstract：
BACKGROUND:Recent meta-analyses failed to support the reliability of ultrasound assessment of the inferior vena cava (IVC) to predict fluid responsiveness. However, the techniques utilized were heterogeneous. We hypothesized that the variability of the elliptic section and caliber of the IVC along its course may influence ultrasound evaluation. Therefore, we investigated IVC size and shape at four levels, before and after a fluid challenge. METHODS:Twenty mechanically-ventilated adult patients who received a fluid challenge after cardiac surgery were enrolled. They were regarded as responders if the cardiac index increased more than 15%. Before and after the fluid challenge, IVC anteroposterior (AP) and lateral (LA) diameters, the flat ratio, and the distensibility index were assessed by ultrasound just above the iliac veins, at the confluence of the renal veins, before the confluence of the hepatic veins (where blood flow velocity was also measured), and after it. RESULTS:At all levels, IVC section was elliptical, so that IVC diameters varied between a minimum and a maximum according to the measurement angle. Such interval increased in correspondence of the renal veins, where IVC section was more eccentric. The distensibility index was higher when assessed on AP diameters. After the fluid challenge, non-responders showed a diffuse increase of AP diameters, whereas responders showed an increase of blood velocity before the confluence of the hepatic veins. CONCLUSIONS:The elliptic section should be considered when assessing IVC size. AP diameters are shorter and more affected by the respiratory cycle. After a fluid challenge, an increase of blood velocity associated with unchanged AP diameters may suggest fluid responsiveness.
journal_name
Minerva Anestesioljournal_title
Minerva anestesiologicaauthors
Biasucci DG,Cina A,Calabrese M,Antoniucci ME,Cavaliere C,Bevilacqua F,Cavaliere Fdoi
10.23736/S0375-9393.18.13041-0subject
Has Abstractpub_date
2019-05-01 00:00:00pages
514-521issue
5eissn
0375-9393issn
1827-1596pii
S0375-9393.18.13041-0journal_volume
85pub_type
杂志文章abstract：:The authors analyze the physiological basis, technical aspects and clinical usefulness of several methods for pressure-volume curves determinations in mechanically ventilatory, acute respiratory failure patients. ...
journal_title：Minerva anestesiologica
pub_type： 杂志文章,评审
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