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Investigation of correlation of inferior vena cava collapsibility index (IVCCI), passive leg raising test (PLRT), central venous pressure (CVP) and lactate and veno-arterial carbondioxide difference (ΔpCO2) for critical intensive care patients

Year 2019, Volume: 58 Issue: 1, 13 - 20, 14.03.2019
https://doi.org/10.19161/etd.418066

Abstract

Aim: Determination the correlation between inferior vena cava collapsibility index (IVCCI), passive leg rising test (PLRT), central venous pressure (CVP), and lactate and veno-arterial carbon dioxide difference (ΔpCO2) parameters that are used for evaluating hypovolemia in critical patients in intensive care units and determining the disposability of ΔpCO2 for this reason.

Materials and Methods: When patients were supine-neutral position, CVP was measured. CVP values less than 8 mmHg (CVP <8 mmHg) were evaluated as hypovolemia. When the patients were at the same position, with the echocardiography (ECHO) probe of ultrasonography device, inferior vena cava (IVC) was monitored and IVCCI values were calculated. IVCCI values larger than 45% (IVCCI >45%) were evaluated as hypovolemia. The patients were applied blood pressure-controlled passive leg lifting test (PLLT), and >12% increase at systolic blood pressure was accepted as positive. After that, simultaneous central venous and arterial blood gas of patients were studied, and ΔpCO2 and arterial lactate levels were controlled.

Results: As a result of our study, we have detected a medium level negative correlation (p=0.02) between IVCCI and CVP, and medium level positive correlation between IVCCI and PLLT. However, weak positive correlation (p=0.032) has been detected between IVCCI and lactate level. Any correlation detected between ΔpCO2 and other parameters.

Conclusion: IVCCI can be used for volume evaluation of intravascular fluid since it is a noninvasive method and at the same time, it is statistically in correlation with CVP, PLLT and lactate.

References

  • Sakr Y, Reinhart K, Vincent JL, et al. Does dopamine administration in shock influence outcome? Results of the Sepsis Occurrence in Acutely Ill Patients (SOAP) Study. Crit Care Med 2006;34(3):589-97.
  • Cecconi M, De Backer D, Antonelli M, et al. Consensus on circulatory shock and hemodynamic monitoring. Task force of the European Society of Intensive Care Medicine. Intensive Care Med 2014;40(12):1795-815.
  • Scerbo MH, Holcomb JB, Taub E, et al. The trauma center is too late: Major limb trauma without a pre-hospital tourniquet has increased death from hemorrhagic shock. J Trauma Acute Care Surge 2017;83(6):1165-72.
  • Marik PE, Linde-Zwirble WT, Bittner EA, Sahatilian J, Hansell D. Fluid administration in severe sepsis and septic shock, patterns and outcomes: An analysis of a large national database. Intensive Care Med 2017;43(5):625-32.
  • Ilyas A, Ishtiaq W, Assad S, et al. Correlation of IVC diameter and collapsibility index with central venous pressure in the assessment of intravascular volume in critically ill patients. Cureus 201712;9(2):e1025.
  • Airapetian N, Maizel J, Alyamani O, et al. Does inferior vena cava respiratory variability predict fluid responsiveness in spontaneously breathing patients? Crit Care 201513;(19):400.
  • Monnet X, Rienzo M, Osman D, et al. Passive leg raising predicts fluid responsiveness in the critically ill. Crit care Med 2006;34(5):1402-7.
  • Mecher CE, Rackow EC, Astiz ME, Weill MH. Venous hypercarbia associated with severe sepsis and systemic hypoperfusion. Crit Care Med 1990;18(6):585-9.
  • Gui J, Yang Z, Ou B, et al. Is the collapsibillity index of the inferior vena cava an accurate predictor for the early detection of intravascular volume change? Shock 2018;49(1):29-32.
  • Thanakitcharu P, Charoenwut M, Siriwiwatanakul N. Inferior vena cava diameter and collapsibility index: A practical non-invasive evaluation of intravascular fluid volume in critically-ill patients. J Med Assoc Thai 2013;96(3):14-22.
  • Vinced L. Annual update in intensive care and emetgency medicine. 38th ISICEM International symposium on İntensive Care and Emergency Medicine;2017 March 20-23, Brussels, Belgium.
  • Mesquida J , Gruartmoner G , Ferrer R. Passive leg raising for assessment of volume responsiveness: A review. Curr Opin Crit Care 2017;23(3):237-243.
  • Caibau H, Guolong C, Jing Y, et al. Bioreactance-based passive leg raising test can predict fluid responsiveness in elderly patients with septic shock. J Emerg Crit Care Med 2017;1(7):1-6.
  • Nguyen HB, Rivers EP, Knoblich BP, et al. Early lactate clearance is associated with improved outcome in severe sepsis and septic shock. Crit Care Med 2004;32:1637-42.
  • Mallat J, Lemyze M, Tronchon M, Vallet B, Thevenin D. Use of venous-to-arterial carbon dioxide tension difference to guide resuscitation therapy in septic shock. World J Crit Care Med 2016;5(1):47-56.
  • Lamia B, Monnet X, Teboul JL. Meaning of arterio-venous PCO2 difference in circulatory shock. Minerva Anestesiol 2006;72(6):597-604.
  • Johnson MC, Alarhayem A, Convertino V, et al. Comparison of compensatory reserve and arterial lactate as markers of shock and resuscitation. J Trauma Acute Care Surg 2017;83(4):603-8.

İnferior vena kava kollapsibilite indeksi (İVCCİ), pasif bacak kaldırma testi (PBKT), santral venöz basınç (CVP), laktat ve veno-arterial karbondioksit farkının (ΔpCO2) kritik yoğun bakım hastalarında korelasyonunun araştırılması

Year 2019, Volume: 58 Issue: 1, 13 - 20, 14.03.2019
https://doi.org/10.19161/etd.418066

Abstract

Amaç: Yoğun bakım ünitesinde yatan kritik hastalarda, hipovoleminin değerlendirmesi için kullandığımız inferior vena kava kollapsibilite indeksi (İVCCİ), santral venöz basınç (CVP), pasif bacak kaldırma testi (PBKT), laktat ve veno-arterial karbondioksit farkı (ΔpCO2) parametrelerinin birbiriyle korelasyonu ve ΔpCO2’in bu amaçla kullanılabilirliğini saptamak.
Gereç ve Yöntem: Hastalar supin-nötr pozisyondayken CVP ölçüldü. CVP’nin <8 mmHg değeri hipovolemi lehine değerlendirildi. Yine aynı pozisyonda ultrasonografi cihazının ekokardiyografi (ECHO) probu ile inferior vena kava (İVC) görüntülemesi yapılıp İVCCİ hesaplandı, İVCCİ’nin >%45 değeri hipovolemi lehine değerlendirildi. Hastaya nabız basınç kontrollü PBKT uygulanıp sistolik tansiyonda >%12 artış pozitif olarak kabul edildi. Daha sonra hastalardan eş zamanlı santral venöz ve arteriel kan gazı çalışılarak ΔpCO2 ve arteriyel laktat düzeyine bakıldı.
Bulgular: Çalışmamızda İVCCİ ve CVP arasında orta derecede negatif korelasyon (p=0.02), İVCCİ ile PBKT arasında orta derecede bir pozitif korelasyon (p<0.001) saptanırken, İVCCİ ile laktat düzeyi arasında zayıf pozitif korelasyon saptandı (p=0.032). ΔpCO2 ile diğer parametreler arasında herhangi bir korelasyon saptanmadı.
Sonuç: İVCCİ’nin, non-invaziv bir yöntem olması ve aynı zamanda CVP, PBKT ve laktatla istatistiksel olarak korele olması nedenleriyle intravasküler sıvı volümü değerlendirmesinde kullanılabileceğini düşünmekteyiz.

References

  • Sakr Y, Reinhart K, Vincent JL, et al. Does dopamine administration in shock influence outcome? Results of the Sepsis Occurrence in Acutely Ill Patients (SOAP) Study. Crit Care Med 2006;34(3):589-97.
  • Cecconi M, De Backer D, Antonelli M, et al. Consensus on circulatory shock and hemodynamic monitoring. Task force of the European Society of Intensive Care Medicine. Intensive Care Med 2014;40(12):1795-815.
  • Scerbo MH, Holcomb JB, Taub E, et al. The trauma center is too late: Major limb trauma without a pre-hospital tourniquet has increased death from hemorrhagic shock. J Trauma Acute Care Surge 2017;83(6):1165-72.
  • Marik PE, Linde-Zwirble WT, Bittner EA, Sahatilian J, Hansell D. Fluid administration in severe sepsis and septic shock, patterns and outcomes: An analysis of a large national database. Intensive Care Med 2017;43(5):625-32.
  • Ilyas A, Ishtiaq W, Assad S, et al. Correlation of IVC diameter and collapsibility index with central venous pressure in the assessment of intravascular volume in critically ill patients. Cureus 201712;9(2):e1025.
  • Airapetian N, Maizel J, Alyamani O, et al. Does inferior vena cava respiratory variability predict fluid responsiveness in spontaneously breathing patients? Crit Care 201513;(19):400.
  • Monnet X, Rienzo M, Osman D, et al. Passive leg raising predicts fluid responsiveness in the critically ill. Crit care Med 2006;34(5):1402-7.
  • Mecher CE, Rackow EC, Astiz ME, Weill MH. Venous hypercarbia associated with severe sepsis and systemic hypoperfusion. Crit Care Med 1990;18(6):585-9.
  • Gui J, Yang Z, Ou B, et al. Is the collapsibillity index of the inferior vena cava an accurate predictor for the early detection of intravascular volume change? Shock 2018;49(1):29-32.
  • Thanakitcharu P, Charoenwut M, Siriwiwatanakul N. Inferior vena cava diameter and collapsibility index: A practical non-invasive evaluation of intravascular fluid volume in critically-ill patients. J Med Assoc Thai 2013;96(3):14-22.
  • Vinced L. Annual update in intensive care and emetgency medicine. 38th ISICEM International symposium on İntensive Care and Emergency Medicine;2017 March 20-23, Brussels, Belgium.
  • Mesquida J , Gruartmoner G , Ferrer R. Passive leg raising for assessment of volume responsiveness: A review. Curr Opin Crit Care 2017;23(3):237-243.
  • Caibau H, Guolong C, Jing Y, et al. Bioreactance-based passive leg raising test can predict fluid responsiveness in elderly patients with septic shock. J Emerg Crit Care Med 2017;1(7):1-6.
  • Nguyen HB, Rivers EP, Knoblich BP, et al. Early lactate clearance is associated with improved outcome in severe sepsis and septic shock. Crit Care Med 2004;32:1637-42.
  • Mallat J, Lemyze M, Tronchon M, Vallet B, Thevenin D. Use of venous-to-arterial carbon dioxide tension difference to guide resuscitation therapy in septic shock. World J Crit Care Med 2016;5(1):47-56.
  • Lamia B, Monnet X, Teboul JL. Meaning of arterio-venous PCO2 difference in circulatory shock. Minerva Anestesiol 2006;72(6):597-604.
  • Johnson MC, Alarhayem A, Convertino V, et al. Comparison of compensatory reserve and arterial lactate as markers of shock and resuscitation. J Trauma Acute Care Surg 2017;83(4):603-8.
There are 17 citations in total.

Details

Primary Language Turkish
Subjects Health Care Administration
Journal Section Research Articles
Authors

Murat Arslan 0000-0002-0499-6859

Bedih Balkan 0000-0003-3510-6991

Abdulkadir Yektaş 0000-0003-4400-548X

Süleyman Sabaz 0000-0001-7034-0391

Kübra Yıldırım 0000-0002-7723-7773

Gülsüm Oya Hergünsel 0000-0003-3218-0029

Publication Date March 14, 2019
Submission Date December 13, 2017
Published in Issue Year 2019Volume: 58 Issue: 1

Cite

Vancouver Arslan M, Balkan B, Yektaş A, Sabaz S, Yıldırım K, Hergünsel GO. İnferior vena kava kollapsibilite indeksi (İVCCİ), pasif bacak kaldırma testi (PBKT), santral venöz basınç (CVP), laktat ve veno-arterial karbondioksit farkının (ΔpCO2) kritik yoğun bakım hastalarında korelasyonunun araştırılması. EJM. 2019;58(1):13-20.