Dynamic changes of hepatic vein Doppler velocities predict preload responsiveness in mechanically ventilated critically ill patients

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dc.contributor.authorBruna, Mario
dc.contributor.authorAlfaro, Sebastian
dc.contributor.authorMuñoz, Felipe
dc.contributor.authorCisternas, Liliana
dc.contributor.authorGonzalez, Cecilia
dc.contributor.authorConlledo, Rodrigo
dc.contributor.authorUlloa-Morrison, Rodrigo
dc.contributor.authorHuilcaman, Marcos
dc.contributor.authorRetamal, Jaime
dc.contributor.authorCastro, Ricardo
dc.contributor.authorRola, Philippe
dc.contributor.authorWong, Adrian
dc.date.accessioned2024-11-14T19:12:15Z
dc.date.available2024-11-14T19:12:15Z
dc.date.issued2024-12
dc.descriptionIndexación: Scopus.
dc.description.abstractBackground: 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.
dc.description.urihttps://icm-experimental.springeropen.com/articles/10.1186/s40635-024-00631-w
dc.identifier.doi10.1186/s40635-024-00631-w
dc.identifier.issn2197-425X
dc.identifier.urihttps://repositorio.unab.cl/handle/ria/62008
dc.language.isoen
dc.publisherIntensive Care Medicine Experimental, Volume 12, Issue 1 December 2024 Article number 46
dc.rights.licenseAttribution 4.0 International CC BY 4.0 Deed
dc.rights.urihttps://creativecommons.org/licenses/by/4.0/
dc.subjectadult
dc.subjectAPACHE
dc.subjectArticle
dc.subjectartificial ventilation
dc.subjectcentral venous oxygen saturation
dc.subjectcentral venous pressure
dc.subjectclinical article
dc.subjectclinical assessment
dc.subjectcontrolled study
dc.subjectcritically ill patient
dc.subjectdemographics
dc.subjectdiagnostic test accuracy study
dc.subjectdynamic change
dc.subjectdynamics
dc.subjectechocardiography
dc.subjectechography
dc.subjectextracorporeal oxygenation
dc.subjectfemale
dc.subjectheart ejection fraction
dc.subjecthemodynamic monitoring
dc.subjecthemodynamic parameters
dc.subjecthepatic vein doppler velocity
dc.subjecthepatic vein morphology
dc.subjecthuman
dc.subjectimage analysis
dc.subjectliver vein
dc.subjectmale
dc.subjectmean arterial pressure
dc.subjectmechanically ventilated critically ill patient
dc.subjectmiddle aged
dc.subjectmorphology
dc.subjectmortality
dc.subjectobservational study
dc.subjectoxygen saturation
dc.subjectprediction
dc.subjectScoring system
dc.subjectSequential Organ Failure Assessment Score
dc.subjecttissue Doppler imaging
dc.subjectTranspulmonary thermodilution
dc.subjectVenous excess ultrasound score
dc.titleDynamic changes of hepatic vein Doppler velocities predict preload responsiveness in mechanically ventilated critically ill patients
dc.typeArtículo
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