Department of Trauma Surgery and Surgical Critical Care, Marshfield Medical Center, Marshfield, WI, USA.
Division of Pulmonary and Critical Care Medicine, Oregon Health and Science University, Portland, OR, USA.
Echocardiography. 2021 Feb;38(2):238-248. doi: 10.1111/echo.14970. Epub 2021 Jan 11.
Limited data exist on the utility of ultrasonographic evaluation of inferior vena cava (IVC) in acute respiratory distress syndrome (ARDS). We studied the value of IVC diameter in assessing cardio-circulatory performance in ARDS using strain echocardiography.
Retrospective cross-sectional analysis of Doppler echocardiograms of patients with moderate-severe ARDS was performed. Right ventricle (RV) parameters, IVC diameter, and left ventricle (LV) systolic and diastolic parameters were collected. RV free wall strain (RVFWS) and LV global longitudinal strain (LVGLS) were calculated.
Fifty-one patients were dichotomized into two groups: with IVC > 2.1 cm (dilated) and with IVC ≤ 2.1 cm (nondilated). The dilated IVC group presented worse hypoxemic profile, hypotension, and poor perfusion markers. No significant associations with positive end-expiratory pressure or lung mechanics were observed. Dilated IVC was associated with impaired RV function, high central venous pressure, elevated pulmonary artery pressure, and LV systolic and diastolic dysfunctions. Strongest predictors of a dilated IVC were RVFWS, LVGLS, and tissue Doppler mitral annular early diastolic velocity. Dilated IVC predicted a global cardiac dysfunction defined by strain echocardiography (GCDS) with high sensitivity and specificity.
In ARDS, strain echocardiography analyses demonstrated that a dilated IVC is associated with GCDS and impaired hemodynamics independent of lung mechanics. A dilated IVC should be considered a marker of circulatory distress, signaling the potential necessity for improved hemodynamic optimization.
关于超声评估急性呼吸窘迫综合征（ARDS）下腔静脉（IVC）的实用性，目前仅有有限的数据。我们使用应变超声心动图研究了 IVC 直径在评估 ARDS 中心血管性能中的价值。
对中重度 ARDS 患者的多普勒超声心动图进行回顾性横断面分析。收集右心室（RV）参数、IVC 直径以及左心室（LV）收缩和舒张参数。计算 RV 游离壁应变（RVFWS）和 LV 整体纵向应变（LVGLS）。
51 名患者分为两组：IVC＞2.1cm（扩张）和 IVC≤2.1cm（非扩张）。扩张 IVC 组存在更差的低氧血症特征、低血压和灌注不良标志物。与呼气末正压或肺力学无显著相关性。扩张 IVC 与 RV 功能障碍、中心静脉压升高、肺动脉压升高以及 LV 收缩和舒张功能障碍有关。扩张 IVC 的最强预测因子是 RVFWS、LVGLS 和组织多普勒二尖瓣环早期舒张速度。扩张 IVC 可预测应变超声心动图定义的整体心脏功能障碍（GCDS），具有高灵敏度和特异性。
在 ARDS 中，应变超声心动图分析表明，扩张的 IVC 与 GCDS 和独立于肺力学的血流动力学障碍相关。扩张的 IVC 应被视为循环窘迫的标志物，表明可能需要优化血流动力学。
