Key result
Vena cava pressure collapsibility index ≥5% predicted fluid responsiveness (arterial pulse pressure variation ≥13%) with 91% specificity, 89% sensitivity, and an AUC of 0.90.
Why the study?
Does the dynamic evaluation of central venous pressure amplitude predict fluid responsiveness in postcardiac surgery patients under mechanical ventilation?
Observational (n=30)
Does the dynamic evaluation of central venous pressure amplitude predict fluid responsiveness in postcardiac surgery patients under mechanical ventilation?
Vena cava pressure collapsibility index (Cvci) is a reliable predictor of fluid responsiveness in mechanically ventilated postcardiac surgery patients, comparable to arterial pulse pressure variation.
Answers are grounded in this paper and cite their sources.
May support vena cava pressure collapsibility index for fluid responsiveness assessment in ventilated postcardiac surgery patients; leaves open prospective validation before adoption.
We tested the hypothesis that the dynamic evaluation of central venous pressure (CVP) amplitude could be a reliable predictor of fluid responsiveness in patients under mechanical ventilation, similar to the variation of arterial pulse pressure (DeltaPp). Thirty postcardiac surgery patients, under mechanical ventilation, were evaluated. The percentual difference between inspiratory (Ppins) and expiratory pulse pressure (Ppins) was so calculated: DeltaPp (%) = 100 x (Ppins - Ppexp)/[(Ppins + Ppexp)/2]. The respiratory variation of CVP curves amplitude were calculated by determining the percentual difference between inspiratory (CVPpins) and expiratory (CVPpexp) variation using vena cava "pressure" collapsibility index according the following formula: Cvci (%) = [(CVPpexp - CVPpins)/CVPpexp] x 100. There was a correlation between DeltaPp and Cvci (Pearson correlation coefficient, r = 0.45). Receiver operating characteristic curves showed that the Cvci value more than or equal to 5% predicted DeltaPp more than or equal to 13% with 91% specificity, 89% sensitivity, and AUC of 0.90. Therefore, Cvci presented a good agreement with DeltaPp (kappa = 0.76) to identify potential fluid responders (patients with DeltaPp > or =13%). In 9 potential fluid responders, both DeltaPp and Cvci significantly decreased from 18% +/- 8% to 8% +/- 6% (P < 0.004) and 23% +/- 15% to 7% +/- 6% (P < 0.004), respectively, after fluid replacement. Our findings suggest that vena cava "pressure" collapsibility index can be used as a marker of fluid responsiveness in postcardiac surgery patients under mechanical ventilation, such as arterial pulse pressure respiratory variation.
No takes yet. Share an insight, caveat, or question.
Westphal et al. (2006) conducted an observational in Postcardiac surgery (n=30). Vena cava pressure collapsibility index (Cvci) vs. Arterial pulse pressure variation (DeltaPp) was evaluated on Prediction of fluid responsiveness (DeltaPp ≥13%) (AUC 0.90). Vena cava pressure collapsibility index ≥5% predicted fluid responsiveness (arterial pulse pressure variation ≥13%) with 91% specificity, 89% sensitivity, and an AUC of 0.90.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: