Comparison between respiratory changes in the inferior vena cava diameter and pulse pressure variation to predict fluid responsiveness in postoperative patients
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2016
Autores
de Oliveira, Olivia Haun [UNIFESP]
Rezende de Freitas, Flavio Geraldo [UNIFESP]
Ladeira, Renata Teixeira [UNIFESP]
Fischer, Claudio Henrique [UNIFESP]
Bafi, Antonio Tonete [UNIFESP]
Pontes Azevedo, Luciano Cesar [UNIFESP]
Machado, Flavia Ribeiro [UNIFESP]
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Purpose: The objective of our study was to assess the reliability of the distensibility index of the inferior vena cava (dIVC) as a predictor of fluid responsiveness in postoperative, mechanically ventilated patients and compare its accuracy with that of the pulse pressure variation (PPV) measurement. Materials and methods: We included postoperative mechanically ventilated and sedated patients who underwent volume expansion with 500 mL of crystalloids over 15 minutes. A response to fluid infusion was defined as a 15% increase in the left ventricular outflow tract velocity time integral according to transthoracic echocardiography. The inferior vena cava diameters were recorded by a subcostal view using the M-mode and the PPV by automatic calculation. The receiver operating characteristic (ROC) curves were generated for the baseline dIVC and PPV. Results: Twenty patients were included. The area under the ROC curve for dIVC was 0.84 (95% confidence interval, 0.63-1.0), and the best cutoff value was 16% (sensitivity, 67%
specificity, 100%). The area under the ROC curve for PPV was 0.92 (95% confidence interval, 0.76-1.0), and the best cutoff was 12.4% (sensitivity, 89%
specificity, 100%). A noninferiority test showed that dIVC cannot replace PPV to predict fluid responsiveness (P = .28). Conclusion: The individual PPV discriminative properties for predicting fluid responsiveness in postoperative patients seemed superior to those of dIVC. (C) 2016 Elsevier Inc. All rights reserved.
specificity, 100%). The area under the ROC curve for PPV was 0.92 (95% confidence interval, 0.76-1.0), and the best cutoff was 12.4% (sensitivity, 89%
specificity, 100%). A noninferiority test showed that dIVC cannot replace PPV to predict fluid responsiveness (P = .28). Conclusion: The individual PPV discriminative properties for predicting fluid responsiveness in postoperative patients seemed superior to those of dIVC. (C) 2016 Elsevier Inc. All rights reserved.
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Journal Of Critical Care. Philadelphia, v. 34, p. 46-49, 2016.