Internal jugular vein distensibility variation and inferior vena cava collapsibility variation with fluid resuscitation as an indicator for fluid management in spontaneously breathing septic patients

Q: What is the clinical evidence from this study?

Study design: Cross-Sectional. Population: Sepsis (n=40). Intervention: Internal jugular vein distensibility index (IJV-DI) and inferior vena cava collapsibility index (IVC-CI) vs. Non-responders (change in cardiac index < 15%). Primary outcome: Predictive power for fluid responsiveness (change in cardiac index ≥ 15%) (AUC 0.97 for IVC-CI and 0.96 for IJV-DI, 95% CI 0.861-0.999, p=<0.001).

Ahmad Mohamad Rashad Elsaeed; Bassel Mohamed Essam Nor El-Din; Waleed Abdelmegeed Mohamed El Taher; Raham Hasan Mostafa; Ashraf Nabil Saleh

doi:10.1186/s42077-022-00226-1

March 10, 2022Ain-Shams Journal of AnaesthesiologyOpen Access

Internal jugular vein distensibility variation and inferior vena cava collapsibility variation with fluid resuscitation as an indicator for fluid management in spontaneously breathing septic patients

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Key result

Both the inferior vena cava collapsibility index (AUC 0.97) and internal jugular vein distensibility index (AUC 0.96) strongly predicted fluid responsiveness in spontaneously breathing septic patients.

Why the study?

Because static indicators of fluid responsiveness are often useless and dynamic predictors are needed to optimize fluid resuscitation in sepsis, this study evaluated dynamic ultrasound indices in spontaneously breathing patients.

Do internal jugular vein distensibility index and inferior vena cava collapsibility index predict fluid responsiveness in spontaneously breathing septic patients?

Key Points

To assess the predictive accuracy of the internal jugular vein distensibility index (IJV-DI) and inferior vena cava collapsibility index (IVC-CI) for fluid responsiveness in spontaneously breathing septic patients.
Evaluated 40 spontaneously breathing adult septic patients admitted to a single university teaching hospital ICU.
Measured baseline IJV-DI and IVC-CI prior to administering a fluid challenge of 7 ml/kg crystalloid.
Classified patients as fluid responders if cardiac index increased by ≥ 15% following resuscitation.
Sixty percent of patients were classified as fluid responders following resuscitation.
IJV-DI (> 17.56%) predicted fluid responsiveness with an area under the ROC curve of 0.96, sensitivity of 95.83%, and specificity of 87.5%.
IVC-CI (> 35%) predicted fluid responsiveness with an area under the ROC curve of 0.97, sensitivity of 95.8%, and specificity of 93.7%.

Study Design

Type

Cross-Sectional (n=40)

Multicenter

No

Structured PICO

Do internal jugular vein distensibility index and inferior vena cava collapsibility index predict fluid responsiveness in spontaneously breathing septic patients?

P

Population

40 spontaneously breathing adult septic patients evaluated for fluid responsiveness using ultrasound indices after a 30-minute volume expansion.

E

Exposure

Measurement of internal jugular vein distensibility index (IJV-DI) and inferior vena cava collapsibility index (IVC-CI) via ultrasound to predict fluid responsiveness to a 30-min volume expansion with 7 ml/kg crystalloid (Ringer Acetate).

O

Outcome

Predictive power of internal jugular vein distensibility index and inferior vena cava collapsibility index for fluid responsiveness (defined as ≥15% increase in cardiac index after fluid resuscitation).surrogate

Main Result

Effect estimate: AUC 0.97 for IVC-CI and 0.96 for IJV-DI (95% CI 0.861-0.999)

p-value: p=<0.001

Both internal jugular vein distensibility index and inferior vena cava collapsibility index are highly accurate, non-invasive dynamic predictors of fluid responsiveness in spontaneously breathing septic patients.

Limitations

Accuracy of measuring cardiac output by velocity time integral requires good echogenicity and skilled personnel
Intra-abdominal pressure was not measured
Carotid artery pulsation may cause bias in measuring internal jugular vein diameter
Did not study the prediction of indices in ventilated patients
Accuracy of measuring cardiac output by VTI requires good echogenicity and skilled personnel
Carotid artery pulsation may cause bias in IJV diameter measurement
Not studied in ventilated patients

Ask about this paper

Answers are grounded in this paper and cite their sources.

Implication

May aid non-invasive fluid assessment in spontaneous-breathing sepsis; leaves open prospective validation before practice change.

Abstract

Background Sepsis is one of the leading causes of death in ICU patients. Fluid resuscitation is the main target in septic patients. Proper fluid administration is needed in septic patients to overcome generalized vasodilatation and capillary leak, this capillary leak itself may cause tissue edema and worsen septic patients. On the other hand, vasopressors may improve tissue perfusion or worsen tissue hypoxia. Therefore, predictors for fluid responsiveness are urgently needed. However, many studies have found static indicators useless. That is why dynamic predictors for fluid responsiveness are attracting growing interest to optimize patients. Our goal is to assess the predictive power of internal jugular vein distensibility index and inferior vena cava collapsibility index for fluid responsiveness in spontaneously breathing septic patients. Forty adult septic patients were enrolled from a single university teaching hospital’s ICU. We measured the Internal jugular distensibility index (IJV-DI) and Inferior vena cava collapsibility index (IVC-CI) in spontaneously breathing septic patients. Patients were considered responders if they had a change in cardiac index (≥ 15%) after fluid resuscitation with 7 ml/kg crystalloid. The main outcome measure is predictive power of Internal jugular vein distensibility index and Inferior vena cava collapsibility index. Results Data from 40 spontaneously breathing septic patients were analyzed. Sixty percent of the patients were fluid responder. The areas under curve of receiver operating characteristic for Internal jugular vein distensibility index and Inferior vena cava collapsibility index to predict fluid responsiveness were 0.96 and 0.97, respectively. IJV-DI (> 17.56%) was predictive of fluid responsiveness with 95.83% sensitivity and 87.5% specificity. IVC-CI (> 35%) was predictive of fluid responsiveness with 95.8% sensitivity and 93.7% specificity. Conclusions Both IJV-DI and IVC-CI have near good predictive value for fluid responsiveness in spontaneously breathing septic patients.

Discussion

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Cite This Study

Elsaeed et al. (2022) conducted a cross-sectional in Sepsis (n=40). Internal jugular vein distensibility index (IJV-DI) and inferior vena cava collapsibility index (IVC-CI) vs. Non-responders (change in cardiac index < 15%) was evaluated on Predictive power for fluid responsiveness (change in cardiac index ≥ 15%) (AUC 0.97 for IVC-CI and 0.96 for IJV-DI, 95% CI 0.861-0.999, p=<0.001). Both the inferior vena cava collapsibility index (AUC 0.97) and internal jugular vein distensibility index (AUC 0.96) strongly predicted fluid responsiveness in spontaneously breathing septic patients.

synapsesocial.com/papers/6a8423a1d87e21f83cb2942c https://doi.org/10.1186/s42077-022-00226-1

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Internal jugular vein distensibility variation and inferior vena cava collapsibility variation with fluid resuscitation as an indicator for fluid management in spontaneously breathing septic patients

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Internal jugular vein distensibility variation and inferior vena cava collapsibility variation with fluid resuscitation as an indicator for fluid management in spontaneously breathing septic patients

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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