The Assessment of Circulating Volume Using Inferior Vena Cava Collapse Index and Carotid Doppler Velocity Time Integral in Healthy Volunteers: a Pilot Study

Overview

Journal Scand J Trauma Resusc Emerg Med

Publisher Biomed Central

Specialty Emergency Medicine

Date 2016 Sep 4

PMID 27590048

Citations 8

Authors

Tom Peachey

Andrew Tang

Elinor C Baker

Jason Pott

Yonathan Freund

Tim Harris

Affiliations

Soon will be listed here.

Abstract

Background: Assessment of circulating volume and the requirement for fluid replacement are fundamental to resuscitation but remain largely empirical. Passive leg raise (PLR) may determine fluid responders while avoiding potential fluid overload. We hypothesised that inferior vena cava collapse index (IVCCI) and carotid artery blood flow would change predictably in response to PLR, potentially providing a non-invasive tool to assess circulating volume and identifying fluid responsive patients.

Methods: We conducted a prospective proof of concept pilot study on fasted healthy volunteers. One operator measured IVC diameter during quiet respiration and sniff, and carotid artery flow. Stroke volume (SV) was also measured using suprasternal Doppler. Our primary endpoint was change in IVCCI after PLR. We also studied changes in IVCCI after "sniff", and correlation between carotid artery flow and SV.

Results: Passive leg raise was associated with significant reduction in the mean inferior vena cava collapsibility index from 0.24 to 0.17 (p < 0.01). Mean stroke volume increased from 56.0 to 69.2 mL (p < 0.01). There was no significant change in common carotid artery blood flow. Changes in physiology consequent upon passive leg raise normalised rapidly.

Discussion: Passive leg raise is associated with a decrease of IVCCI and increase in stroke volume. However, the wide range of values observed suggests that factors other than circulating volume predominate in determining the proportion of collapse with respiration.

Conclusion: In contrast to other studies, we did not find that carotid blood flow increased with passive leg raise. Rapid normalisation of post-PLR physiology may account for this.

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References

Gassner M, Killu K, Bauman Z, Coba V, Rosso K, Blyden D . Feasibility of common carotid artery point of care ultrasound in cardiac output measurements compared to invasive methods. J Ultrasound. 2015; 18(2):127-33. PMC: 4504859. DOI: 10.1007/s40477-014-0139-9. View

Schmid E, Spahn D, Tornic M . Reliability of a new generation transesophageal Doppler device for cardiac output monitoring. Anesth Analg. 1993; 77(5):971-9. DOI: 10.1213/00000539-199311000-00017. View

Chong S, Peyton P . A meta-analysis of the accuracy and precision of the ultrasonic cardiac output monitor (USCOM). Anaesthesia. 2012; 67(11):1266-71. DOI: 10.1111/j.1365-2044.2012.07311.x. View

Lanspa M, Grissom C, Hirshberg E, Jones J, Brown S . Applying dynamic parameters to predict hemodynamic response to volume expansion in spontaneously breathing patients with septic shock. Shock. 2013; 39(2):155-60. PMC: 3580843. DOI: 10.1097/SHK.0b013e31827f1c6a. View

Dabrowski G, Steinberg S, Ferrara J, Flint L . A critical assessment of endpoints of shock resuscitation. Surg Clin North Am. 2000; 80(3):825-44. DOI: 10.1016/s0039-6109(05)70098-0. View

Marik P, Levitov A, Young A, Andrews L . The use of bioreactance and carotid Doppler to determine volume responsiveness and blood flow redistribution following passive leg raising in hemodynamically unstable patients. Chest. 2012; 143(2):364-370. DOI: 10.1378/chest.12-1274. View

van Lelyveld-Haas L, van Zanten A, Borm G, Tjan D . Clinical validation of the non-invasive cardiac output monitor USCOM-1A in critically ill patients. Eur J Anaesthesiol. 2008; 25(11):917-24. DOI: 10.1017/S0265021508004882. View

Weekes A, Tassone H, Babcock A, Quirke D, Norton H, Jayarama K . Comparison of serial qualitative and quantitative assessments of caval index and left ventricular systolic function during early fluid resuscitation of hypotensive emergency department patients. Acad Emerg Med. 2011; 18(9):912-21. DOI: 10.1111/j.1553-2712.2011.01157.x. View

Panebianco N, Shofer F, Cheng A, Fischer J, Cody K, Dean A . The effect of supine versus upright patient positioning on inferior vena cava metrics. Am J Emerg Med. 2014; 32(11):1326-9. DOI: 10.1016/j.ajem.2014.07.036. View

10.

Levine A, Shah S, Umulisa I, Mark Munyaneza R, Dushimiyimana J, Stegmann K . Ultrasound assessment of severe dehydration in children with diarrhea and vomiting. Acad Emerg Med. 2010; 17(10):1035-41. DOI: 10.1111/j.1553-2712.2010.00830.x. View

11.

Maizel J, Airapetian N, Lorne E, Tribouilloy C, Massy Z, Slama M . Diagnosis of central hypovolemia by using passive leg raising. Intensive Care Med. 2007; 33(7):1133-1138. DOI: 10.1007/s00134-007-0642-y. View

12.

Baker E, Pott J, Khan F, Freund Y, Harris T . Best approach to measuring the inferior vena cava in spontaneously ventilating patients: a pilot study. Eur J Emerg Med. 2014; 22(1):58-61. DOI: 10.1097/MEJ.0000000000000148. View

13.

Muller L, Bobbia X, Toumi M, Louart G, Molinari N, Ragonnet B . Respiratory variations of inferior vena cava diameter to predict fluid responsiveness in spontaneously breathing patients with acute circulatory failure: need for a cautious use. Crit Care. 2012; 16(5):R188. PMC: 3682290. DOI: 10.1186/cc11672. View

14.

Delerme S, Renault R, Le Manach Y, Lvovschi V, Bendahou M, Riou B . Variations in pulse oximetry plethysmographic waveform amplitude induced by passive leg raising in spontaneously breathing volunteers. Am J Emerg Med. 2007; 25(6):637-42. DOI: 10.1016/j.ajem.2006.11.035. View

15.

Yanagawa Y, Sakamoto T, Okada Y . Hypovolemic shock evaluated by sonographic measurement of the inferior vena cava during resuscitation in trauma patients. J Trauma. 2008; 63(6):1245-8. DOI: 10.1097/TA.0b013e318068d72b. View

16.

Boulain T, Achard J, Teboul J, Richard C, Perrotin D, Ginies G . Changes in BP induced by passive leg raising predict response to fluid loading in critically ill patients. Chest. 2002; 121(4):1245-52. DOI: 10.1378/chest.121.4.1245. View

17.

Feissel M, Michard F, Faller J, Teboul J . The respiratory variation in inferior vena cava diameter as a guide to fluid therapy. Intensive Care Med. 2004; 30(9):1834-7. DOI: 10.1007/s00134-004-2233-5. View

18.

Vieillard-Baron A, Chergui K, Rabiller A, Peyrouset O, Page B, Beauchet A . Superior vena caval collapsibility as a gauge of volume status in ventilated septic patients. Intensive Care Med. 2004; 30(9):1734-9. DOI: 10.1007/s00134-004-2361-y. View

19.

Barbier C, Loubieres Y, Schmit C, Hayon J, Ricome J, Jardin F . Respiratory changes in inferior vena cava diameter are helpful in predicting fluid responsiveness in ventilated septic patients. Intensive Care Med. 2004; 30(9):1740-6. DOI: 10.1007/s00134-004-2259-8. View

20.

Thiel S, Kollef M, Isakow W . Non-invasive stroke volume measurement and passive leg raising predict volume responsiveness in medical ICU patients: an observational cohort study. Crit Care. 2009; 13(4):R111. PMC: 2750155. DOI: 10.1186/cc7955. View