Performance of a 25% Inferior Vena Cava Collapsibility in Detecting Fluid Responsiveness When Assessed by Novice Versus Expert Physician Sonologists. (December 2020)

• Record Type: Journal Article
• Authors: Corl, Keith A.; Azab, Nader; Nayeemuddin, Mohammed; Schick, Alexandra; Lopardo, Thomas; Zeba, Fatima; Phillips, Gary; Baird, Grayson; Merchant, Roland C.; Levy, Mitchell M.; Blaivas, Michael; Abbasi, Adeel
• Is Part Of: Journal of intensive care medicine. Volume 35:Number 12(2020)
• Page Start: 1520
• Page End: 1528
• Publication Date: 2020-12
• Subjects: inferior vena cava -- point-of-care ultrasound -- fluid responsiveness -- spontaneously breathing -- novice sonologist; Critical care medicine -- Periodicals; Critical Care -- Periodicals; Soins intensifs -- Périodiques; Soins intensifs; Périodique électronique (Descripteur de forme); Ressource Internet (Descripteur de forme); 616.02805
• DOI: 10.1177/0885066619881123
• Languages: English
• ISSNs: 0885-0666

Abstract

Objectives: Inferior vena cava collapsibility (cIVC) measured by point-of-care ultrasound (POCUS) has been proposed as a noninvasive means of assessing fluid responsiveness. We aimed to prospectively evaluate the performance of a 25% cIVC cutoff value to detect fluid responsiveness among spontaneously breathing intensive care unit (ICU) patients when assessed with POCUS by novice versus expert physician sonologists. Methods: Prospective observational study of spontaneously breathing ICU patients. Fluid responsiveness was defined as a> 10% increase in cardiac index following a 500 mL fluid bolus, measured by bioreactance. Novice sonologist measured cIVC with POCUS. Their measurements were later compared to an expert physician sonologist who independently reviewed the POCUS images and assessed cIVCs. Results: Of the 85 participants, 44 (52%) were fluid responders. A 25% cIVC cutoff value performed better when assessed by expert sonologists than novice physician sonologists (receiver–operator characteristic curve, ROC = 0.82 [0.74-0.88] vs ROC = 0.69 [0.60-0.77]). Conclusions: A 25% cIVC cutoff value measured by POCUS detects fluid responsiveness. However, the experience of the physician sonologist affects test performance and should be considered when interpreting and clinically using cIVC to direct intravenous fluid resuscitation.