Dynamic changes of hepatic vein Doppler velocities predict preload responsiveness in mechanically ventilated critically ill patients
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Archivos
Fecha
2024-12
Profesor/a Guía
Facultad/escuela
Idioma
en
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Título del volumen
Editor
Intensive Care Medicine Experimental, Volume 12, Issue 1 December 2024 Article number 46
Nombre de Curso
Licencia CC
Attribution 4.0 International
CC BY 4.0
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Licencia CC
https://creativecommons.org/licenses/by/4.0/
Resumen
Background: Assessment of dynamic parameters to guide fluid administration is one of the mainstays of current resuscitation strategies. Each test has its own limitations, but passive leg raising (PLR) has emerged as one of the most versatile preload responsiveness tests. However, it requires real-time cardiac output (CO) measurement either through advanced monitoring devices, which are not routinely available, or echocardiography, which is not always feasible. Analysis of the hepatic vein Doppler waveform change, a simpler ultrasound-based assessment, during a dynamic test such as PLR could be useful in predicting preload responsiveness. The objective of this study was to assess the diagnostic accuracy of hepatic vein Doppler S and D-wave velocities during PLR as a predictor of preload responsiveness. Methods: Prospective observational study conducted in two medical–surgical ICUs in Chile. Patients in circulatory failure and connected to controlled mechanical ventilation were included from August to December 2023. A baseline ultrasound assessment of cardiac function was performed. Then, simultaneously, ultrasound measurements of hepatic vein Doppler S and D waves and cardiac output by continuous pulse contour analysis device were performed during a PLR maneuver. Results: Thirty-seven patients were analyzed. 63% of the patients were preload responsive defined by a 10% increase in CO after passive leg raising. A 20% increase in the maximum S wave velocity after PLR showed the best diagnostic accuracy with a sensitivity of 69.6% (49.1–84.4) and specificity of 92.8 (68.5–99.6) to detect preload responsiveness, with an area under curve of receiving operator characteristic (AUC–ROC) of 0.82 ± 0.07 (p = 0.001 vs. AUC–ROC of 0.5). D-wave velocities showed worse diagnostic accuracy. Conclusions: Hepatic vein Doppler assessment emerges as a novel complementary technique with adequate predictive capacity to identify preload responsiveness in patients in mechanical ventilation and circulatory failure. This technique could become valuable in scenarios of basic hemodynamic monitoring and when echocardiography is not feasible. Future studies should confirm these results. © The Author(s) 2024.
Notas
Indexación: Scopus.
Palabras clave
adult, APACHE, Article, artificial ventilation, central venous oxygen saturation, central venous pressure, clinical article, clinical assessment, controlled study, critically ill patient, demographics, diagnostic test accuracy study, dynamic change, dynamics, echocardiography, echography, extracorporeal oxygenation, female, heart ejection fraction, hemodynamic monitoring, hemodynamic parameters, hepatic vein doppler velocity, hepatic vein morphology, human, image analysis, liver vein, male, mean arterial pressure, mechanically ventilated critically ill patient, middle aged, morphology, mortality, observational study, oxygen saturation, prediction, Scoring system, Sequential Organ Failure Assessment Score, tissue Doppler imaging, Transpulmonary thermodilution, Venous excess ultrasound score
Citación
DOI
10.1186/s40635-024-00631-w