A clinical investigation about using bedside ultrasound via chest wall to predict fluid responsiveness in acute circulatory failure patients with mechanical ventilation

Wang Run-ze; Zhou Shu-sheng; Liu Bao; Zha Yu; Huang Yu; Wang Chun-yan; Cao Xiao-guang

doi:10.3969/j.issn.1002-1949.2017.12.014

Abstract：Objective To This study would evaluate the value of measurement of internal jugular vein (IJVR) collapsibility and inferior vena cava (IVCR) in fluid responsiveness.Methods This study was a prospective clinical analysis and 56 mechanically ventilated patients were assessed.Ultrasound of IJVR dimensions was performed before and after fluid challenge (500 mL colloid fluid bolus).IJVR collapsibility was calculated as (IJVmax-IJVmin)/IJVmax and expressed as a percentage.Central venous pressure (CVP) and IVCR collapsibility were also collected.We would evaluate the value of IJVR collapsibility,CVP and IVCR collapsibility by the sensitivity,specificity and likelihood ratios of receiver operating characteristic (ROC) curves in predicting volume responsiveness.Results We enrolled 56 patients,32 were responsiveness (57％) and 24 (43％) were no responsiveness.IJVR and △SV were correlated (r =0.809,P ＜ 0.05).Fluid responsiveness was defined when collapsibility value for IJVR was ≥ 13％.The area under the ROC curve was 0.735 (95％ CI 0.603～ 0.866),with a sensitivity of 85.7％ and specificity of 70.3％.Fluid responsiveness was defined when collapsibility value for IVCR was ≥ 18.7％.The area under the ROC curve was 0.853 (95％ CI 0.696 ～ 0.956),with a sensitivity of 86.7％ and specificity of 83％.Interestingly,combining IJVR collapsibility more than 13％ and IVCR collapsibility more than 18％ predicted fluid responsiveness with a sensitivity of 90.9％ and specificity of 89.3％.But fluid responsiveness was defined when CVP was ≤ 10 cm H2O.The area under the ROC curve was 0.653 (95％ CI 0.441 ～ 0.828),with a sensitivity of 56.7％ and specificity of 50.8％.Conclusion IJVR collapsibility may be an accurate,easily acquired non-invasive parameter of fluid responsiveness in acute circulatory failure.The combined use of IJVR and IVCR can improve the sensitivity and specificity.