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Comparative evaluation of stroke volume variation and inferior vena cava distensibility index for prediction of fluid responsiveness in mechanically ventilated patients


1 Department of Anaesthesiology and Critical Care, Armed Forces Medical College, Pune, Maharashtra, India
2 Department of Anaesthesiologist and Critical Care, RR Hospital, New Delhi, India
3 Department of Internal Medicine, Armed forces Medical College, Pune, Maharashtra, India
4 Department of Ophthalmology, Command Hospital (SC), Pune, Maharashtra, India
5 Department of Respiratory Medicine, MH (CTC), Pune, Maharashtra, India

Correspondence Address:
Shalendra Singh
Department of Anaestheiology and Critical Care, Armed Forces Medical College, Pune - 411 040, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/aca.ACA_113_20

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Year : 2021  |  Volume : 24  |  Issue : 3  |  Page : 327-332

 

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Objectives: To evaluate the correlation between stroke volume variation (SVV) and inferior vena cava distensibility index (dIVC) as a marker for fluid responsiveness in mechanically ventilated hypotensive intensive care unit (ICU) patients. Methodology and Design: This study is designed as prospective observational study conducted in patients admitted to an ICU who were mechanically ventilated and experienced a hypotensive episode. Intervention: A fluid challenge of 10 mL/kg ringer's lactate was given over 20 min. Measurements: Hemodynamic parameters as well as SVV, IVCmax, IVCmin, dIVC, and cardiac output (CO), were recorded at a different time interval. An increase in ≥15% of CO was taken as fluid responsiveness. Results: Out of 67 patients, 67.2% responded to fluid challenge. Pearson's correlation graph at baseline showed a strong positive correlation between dIVC and SVV with r = 0.453, (P < 0.002). Non-responders also had a strong positive correlation (r = 0.474) at the baseline. Bland Altman's analysis of the correlation between dIVC and SVV post-fluid challenge showed a mean difference of – 4.444, with 1.49% of the values falling outside the limits of agreement (18.418 and -27.306). This difference was clinically significant. Pearson's correlation graph post-fluid challenge showed a moderately strong positive correlation between dIVC and SVV with r = 0.298 and P value = 0.047, which was statistically significant. Also, non-responders had a weak correlation as compared to the responder's group, r = 0.364 and P value = 0.095, which was not clinically significant. There was no significant difference in the trend of dIVC and SVV values between the non-surgical and surgical groups, nor was there any gender difference analyzed in the study. Conclusion: This study ascertains the positive correlation between dIVC and SVV and justifies its use in a clinical setting of hypotension suspected to be due to hypovolemia.






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1 Department of Anaesthesiology and Critical Care, Armed Forces Medical College, Pune, Maharashtra, India
2 Department of Anaesthesiologist and Critical Care, RR Hospital, New Delhi, India
3 Department of Internal Medicine, Armed forces Medical College, Pune, Maharashtra, India
4 Department of Ophthalmology, Command Hospital (SC), Pune, Maharashtra, India
5 Department of Respiratory Medicine, MH (CTC), Pune, Maharashtra, India

Correspondence Address:
Shalendra Singh
Department of Anaestheiology and Critical Care, Armed Forces Medical College, Pune - 411 040, Maharashtra
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/aca.ACA_113_20

Rights and Permissions

Objectives: To evaluate the correlation between stroke volume variation (SVV) and inferior vena cava distensibility index (dIVC) as a marker for fluid responsiveness in mechanically ventilated hypotensive intensive care unit (ICU) patients. Methodology and Design: This study is designed as prospective observational study conducted in patients admitted to an ICU who were mechanically ventilated and experienced a hypotensive episode. Intervention: A fluid challenge of 10 mL/kg ringer's lactate was given over 20 min. Measurements: Hemodynamic parameters as well as SVV, IVCmax, IVCmin, dIVC, and cardiac output (CO), were recorded at a different time interval. An increase in ≥15% of CO was taken as fluid responsiveness. Results: Out of 67 patients, 67.2% responded to fluid challenge. Pearson's correlation graph at baseline showed a strong positive correlation between dIVC and SVV with r = 0.453, (P < 0.002). Non-responders also had a strong positive correlation (r = 0.474) at the baseline. Bland Altman's analysis of the correlation between dIVC and SVV post-fluid challenge showed a mean difference of – 4.444, with 1.49% of the values falling outside the limits of agreement (18.418 and -27.306). This difference was clinically significant. Pearson's correlation graph post-fluid challenge showed a moderately strong positive correlation between dIVC and SVV with r = 0.298 and P value = 0.047, which was statistically significant. Also, non-responders had a weak correlation as compared to the responder's group, r = 0.364 and P value = 0.095, which was not clinically significant. There was no significant difference in the trend of dIVC and SVV values between the non-surgical and surgical groups, nor was there any gender difference analyzed in the study. Conclusion: This study ascertains the positive correlation between dIVC and SVV and justifies its use in a clinical setting of hypotension suspected to be due to hypovolemia.






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