Vena Kava İnferior Çapına Göre Sıvı Durumunun Değerlendirilmesi
Synopsis
Determining intravascular volume status and managing fluid administration appropriately in critical patients with sepsis, septic shock, and hypotension is of critical importance for improving vital organ perfusion and tissue oxygenation. Response to fluid resuscitation is explained by the Frank-Starling curve; however, an increase in cardiac output cannot be achieved in approximately 50% of patients, and uncontrolled fluid administration can lead to fluid shifts into the extravascular space and end-organ edema. Central venous pressure (CVP) measurement, a traditional static parameter, has limited reliability because it is an invasive procedure and does not directly correlate with circulating blood volume. In contrast, assessing respiratory variations of inferior vena cava (IVC) diameter (cVCI and dVCI) via bedside non-invasive ultrasonography (USG) is a current and effective dynamic method. In spontaneously breathing patients, IVC diameter decreases during inspiration due to negative intrathoracic pressure, whereas in patients receiving positive pressure mechanical ventilation, increased intrathoracic pressure causes distension of the IVC diameter. Measurements are performed in the supine position from the subcostal window using M-mode, 1-3 cm distal to the hepatic vein or the IVC entry into the right atrium. An IVC diameter of less than 10 mm at end-expiration indicates low blood volume and high fluid responsiveness, while a diameter greater than 25 mm indicates high blood volume and low fluid responsiveness. Furthermore, estimating right atrial pressure and CVP using IVC diameter and collapsibility index in spontaneously breathing patients stands out as a valid method.
References
Sobczyk D, Nycz K, Andruszkiewicz P, et al. Ultrasonographic caval indices do not significantly contribute to predicting fluid responsiveness immediately after coronary artery bypass grafting when compared to passive leg raising. Cardiovascular Ultrasound, 2016;14(1):23.
Russell JA: Management of sepsis. N Engl J Med, 2006;355(16):1699-1713.
Furtado S, Reis L. Inferior vena cava evaluation in fluid therapy de- cision making in intensive care: practical implications. Rev Bras Ter Intensiva, 2019;31(2):240-247.
Durand P, Chevret L, Essouri S, et al. Respiratory variations in aortic blood flow predict fluid responsiveness in ventilated children. Intensive Care Med, 2008;5(34):888-894.
Ognibene FP, Parker MM, Natanson C, et al. Depressed left ventricular performance. Response to volume infusion in patients with sepsis and septic shock. Chest, 1988;93(5):903-910.
Kelm DJ, Perrin JT, Cartin-Ceba R, et al. Fluid overload in patients with severe sepsis and septic shock treated with early goal directed therapy is associated with increased acute need for fluid-relatedmedical interventions and hospital death. Shock, 2015;1(43):68–73.
Hu B, Xiang H, Liang H, Yu L, et al. Assessment effect of central venous pressure in fluid resuscitation in the patients with shock: a multi-center retrospective research. Chin Med J, 2013;126(10):1844-1849.
Marik PE, Baram M, Vahid B. Does the cen- tral venous pressure predict fluid responsiveness ? A systematic review of the literature and the tale of seven mares. Chest 2008;134(1):172-178.
Marik PE, Baram M and Vahid B. Does central venous pressure predict fluid responsiveness?: A systematic review of the literature and the tale of seven mares. Chest, 2008;134(1):172-178.
Monet X, Teboul JL. Volume responsiveness. Curr Opin Crit Care, 2007;13(5):549-553.
Lamia B, Ochagavia A, Monnet X, et al. Echocardiographic prediction of volume responsiveness in critically ill patients with spontaneously breathing activity. Intensive Care Med, 2007;33(7):1125-1132.
Blehar DJ, Resop D, Chin B, et al. Inferior vena cava displacement during respirophasic ultrasound imaging. Critical Ultrasound Journal, 2012;4(1):2-5.
Achar SK, Sagar MS, Shetty R, et al. Respiratory variation in aortic flow peak velocity and inferior vena cava distensibility as indices of fluid responsiveness in anaesthetised and mechanically ventilated children. The Indian Journal of Anaesthesia, 2016;60 (2):121-126.
Ramos FJ, Azevedo LC. Assessment of fluid responsiveness in patients under spontaneous breathing activity. Rev Bras Ter Intensiva, 2009;21(2):212-218.
Furtado S, Reis L. Inferior vena cava evaluation in fluid therapy decision making in intensive care: practical implications. Rev Bras Ter Intensiva, 2019;31(2):240-247.
Caplan M, Durand A, Bortolotti P, et al. Measurement site of inferior vena cava diameter affects the accuracy with which fluid responsiveness can be predicted in spontaneously breathing patients: a post hoc analysis of two prospective cohorts. Ann Intensive Care, 2020;10(1):168.
Lang RM, Badano LP, Mor-Avi V, et al. Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr, 2015;28(1):1-39.
Orde S, Slama M, Hilton A, et al. Pearls and pitfalls in comprehensive critical care echocardiography. Crit Care, 2017;21(1):279.
Feissel M, Michard F, Faller JP, et al. The respiratory variation in inferior vena cava diameter as a guide to fluid therapy. Intensive Care Med, 2004;30(9):1834-1837.
Ciozda W, Kedan I, Kehl DW, et al. The efficacy of sonographic measurement of inferior vena cava diameter as an estimate of central venous pressure. Cardiovasc Ultrasound, 2016;14(1):33.
Levitov A, Frankel HL, Blaivas M, et al. Guidelines for the appropriate use of bedside general and cardiac ultrasonography in the evaluation of critically ill patients - Part II: Cardiac ultrasonography. Crit Care Med, 2016;44(6):1206-1227.
