Inferior vena cava collapsibility index for the assessment of fluid responsiveness among spontaneously breathing preoperative fasting patients - An observational study

• Main Authors: Kiran Kalshetty, Nikahat Jahan, Rangraj Setlur, Alok Jaiswal, Deepak Dwivedi
• Format: Article
• Language: English
• Published: Wolters Kluwer Medknow Publications 2020-01-01
• Series: Journal of Marine Medical Society
• Subjects: collapsibility index; fluid responsiveness; inferior vena cava; ultrasound
• Online Access: http://www.marinemedicalsociety.in/article.asp?issn=0975-3605;year=2020;volume=22;issue=2;spage=151;epage=155;aulast=

Background: It is challenging to assess intravascular volume status for clinicians caring for patients in the perioperative period. Previous studies have recommended the inferior vena cava collapsibility index (IVCCI) to assess the volume status of a patient. However, these studies have been carried out in mechanically ventilated patients with consistent tidal volumes. The evidence for this technique in spontaneously breathing patients is far weaker. This study was performed to assess if IVCCI was increased in spontaneously breathing fasting preoperative patients and if this measure decreased with a fluid bolus. Materials and Methods: After ethical approval and registration, we conducted a prospective study to assess the ability of IVCCI in fasting preoperative patients and the change in IVCCI after a fluid bolus. Fifty adult patients scheduled for surgery, who had been fasting for >6 h, had their IVCCI assessed by scanning of the IVC before and after a 500 ml normal saline intravenous fluid bolus. Results: Prior to the fluid bolus, 46 patients (92%) had an IVCCI of >12%, while 41 patients (82%) had a IVCCI of >12% after a fluid bolus. The mean IVCCI before the fluid bolus was 32.2% (standard deviation [SD] 13.4) and it reduced to a mean IVCCI of 26.3% (SD 20) after administration of a 500 ml fluid bolus, indicating fluid responsiveness. The value of P was < 0.001. Conclusion: In this study, IVCCI in spontaneously breathing patients was both a sensitive indicator of fluid depletion and had a high positive predictive value to identify fluid responsiveness.