Department of Anesthesiology, Nanjing Drum Tower Hospital, The Affiliated Hosptial of Nanjing University Medical School, 321 Zhongshan Road, 210008, Nanjing, China.
BMC Anesthesiol. 2022 Mar 8;22(1):63. doi: 10.1186/s12871-022-01598-5.
The validation of inferior vena cava (IVC) respiratory variation for predicting volume responsiveness is still under debate, especially in spontaneously breathing patients. The present study aims to verify the effectiveness and accuracy of IVC variability for volume assessment in the patients after abdominal surgery under artificially or spontaneously breathing.
A total of fifty-six patients after abdominal surgeries in the anesthesia intensive care unit ward were included. All patients received ultrasonographic examination before and after the fluid challenge of 5 ml/kg crystalloid within 15 min. The same measurements were performed when the patients were extubated. The IVC diameter, blood flow velocity-time integral of the left ventricular outflow tract, and cardiac output (CO) were recorded. Responders were defined as an increment in CO of 15% or more from baseline.
There were 33 (58.9%) mechanically ventilated patients and 22 (39.3%) spontaneously breathing patients responding to fluid resuscitation, respectively. The area under the curve was 0.80 (95% CI: 0.68-0.90) for the IVC dimeter variation (cIVC1) in mechanically ventilated patients, 0.87 (95% CI: 0.75-0.94) for the collapsibility of IVC (cIVC2), and 0.85 (95% CI: 0.73-0.93) for the minimum IVC diameter (IVCmin) in spontaneously breathing patients. The optimal cutoff value was 15.32% for cIVC1, 30.25% for cIVC2, and 1.14 cm for IVCmin. Furthermore, the gray zone for cIVC2 was 30.72 to 38.32% and included 23.2% of spontaneously breathing patients, while 17.01 to 25.93% for cIVC1 comprising 44.6% of mechanically ventilated patients. Multivariable logistic regression analysis indicated that cIVC was an independent predictor of volume assessment for patients after surgery irrespective of breathing modes.
IVC respiratory variation is validated in predicting patients' volume responsiveness after abdominal surgery irrespective of the respiratory modes. However, cIVC or IVCmin in spontaneously breathing patients was superior to cIVC in mechanically ventilated patients in terms of clinical utility, with few subjects in the gray zone for the volume responsiveness appraisal.
ChiCTR-INR-17013093 . Initial registration date was 24/10/2017.
下腔静脉（IVC）呼吸变异度预测容量反应性的验证仍存在争议，尤其是在自主呼吸患者中。本研究旨在验证 IVC 变异度在人工或自主呼吸腹部手术后患者容量评估中的有效性和准确性。
共纳入 56 例腹部手术后在麻醉重症监护病房的患者。所有患者在 15 分钟内接受 5ml/kg 晶体液冲击后进行超声检查。当患者拔管时也进行相同的测量。记录 IVC 直径、左心室流出道血流速度时间积分和心输出量（CO）。反应者定义为 CO 从基线增加 15%或以上。
分别有 33 例（58.9%）机械通气患者和 22 例（39.3%）自主呼吸患者对液体复苏有反应。IVC 直径变化（cIVC1）在机械通气患者中的曲线下面积为 0.80（95%可信区间：0.68-0.90），IVC collapsibility（cIVC2）为 0.87（95%可信区间：0.75-0.94），自主呼吸患者的最小 IVC 直径（IVCmin）为 0.85（95%可信区间：0.73-0.93）。最佳截断值为 cIVC1 为 15.32%，cIVC2 为 30.25%，IVCmin 为 1.14cm。此外，cIVC2 的灰色区域为 30.72%至 38.32%，包括 23.2%的自主呼吸患者，而 cIVC1 的 17.01%至 25.93%包括 44.6%的机械通气患者。多变量逻辑回归分析表明，cIVC 是预测手术后患者容量反应性的独立预测因子，与呼吸模式无关。
IVC 呼吸变异度在预测腹部手术后患者的容量反应性方面是有效的，无论呼吸模式如何。然而，与机械通气患者相比，自主呼吸患者的 cIVC 或 IVCmin 在临床实用性方面优于 cIVC，而在评估容量反应性时，灰色区域的患者较少。
ChiCTR-INR-17013093。初始注册日期为 2017 年 10 月 24 日。
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