Effect of inferior vena cava variability in the assessment of volumetric reactivity in patients with coronary artery bypass grafting

doi:10.3877/cma.j.issn.1674-6880.2017.06.006

Abstract

Abstract:

Objective

To investigate the significance of inferior vena cava variability (IVCV) in the evaluation of volumetric reactivity in patients with coronary artery bypass grafting (CABG).

Methods

Totally 22 mechanical ventilation patients with pulmonary artery catheter (PAC) after CABG were collected, and the passive leg raising (PLR) tests were carried out on them in the first hour of intensive monitoring in the ICU ward. Patients with elevated cardiac output ≥ 15% after PLR were included in the volume-reactive positive group, while patients with elevated cardiac output < 15% were included in the volume-reactive negative group. The hemodynamic parameters of heart rate, arterial blood pressure, central venous pressure, pulmonary artery wedge pressure, cardiac output, end-diastolic volume index (EDVI), stroke volume, and the echocardiographic indexes of the maximum diameter of the inferior vena cava (IVCmax), the minimum diameter of the inferior vena cava (IVCmin) and the IVCV expression were all recorded before and after PLR in both groups. The general data, hemodynamic parameters and echocardiographic indexes of the two groups were compared, and then the predictive value of IVCV to volumetric reactivity was evaluated by the receiver operating characteristic curve (ROC).

Results

The age [(64 ± 8) years vs. (69 ± 6) years], the sex ratio (10/6 vs. 3/3) , the acute physiology and chronic health evaluation (APACHE) Ⅱ scores [(11.6 ± 2.7) vs. (12.7 ± 2.4)], the extracorporeal circulation time [(52 ± 32) min vs. (68 ± 34) min], the mechanical ventilation time [(11 ± 5) h vs. (12 ± 6) h] and the ICU residence time [(1.8 ± 1.0) d vs. (1.7 ± 0.5) d] all showed no statistically significant difference between the two groups (all P > 0.05). The expressions of cardiac output [(4.5 ± 0.8) mL/m² vs. (5.0 ± 0.8) mL/m²], the stroke volume [(56 ± 9) mL vs. (62 ± 11) mL] and the IVCmin [(1.61 ± 0.28) cm vs. (9 ± 3) cm] before PLR were all significantly lower in the volume-reactive positive group compared to the volume-reactive negative group (t = 2.586, 2.236, 4.217; P = 0.012, 0.021, < 0.001). Meanwhile, the expression of IVCV [(21 ± 7)% vs. (68 ± 34)%] was higher in the volume-reactive positive group (t = 9.242, P < 0. 001). ROC curve analysis showed that the area under the curve of IVCV was 0.941 (95%CI: 0.879~1.000, P < 0.001) and it had predictive value for volumetric reactivity of patients after CABG.

Conclusion

IVCV could be used as an effective indicator for volumetric reactivity prediction in patients after CABG.

Key words: Inferior vena cava variability, Volumetric reactivity, Passive leg raising, Coronary artery bypass grafting

Jilai Xiao, Shuai Nie, Wenhao Zhang, Xiaochun Song, Qiankun Shi, Yi Zhao, Qiaolian Xu, Xinwei Mu. Effect of inferior vena cava variability in the assessment of volumetric reactivity in patients with coronary artery bypass grafting[J]. Chinese Journal of Critical Care Medicine(Electronic Edition), 2017, 10(06): 391-396.

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References 20

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组别	例数	年龄（岁）	性别比（例，男/女）	APACHEⅡ评分（分）	体外循环时间（min）	机械通气时间（h）	住ICU时间（d）
容量反应阳性组	16	64 ± 8	10/6	11.6 ± 2.7	52 ± 32	11 ± 5	1.8 ± 1.0
容量反应阴性组	6	69 ± 6	3/3	12.7 ± 2.4	68 ± 34	12 ± 6	1.7 ± 0.5
t/χ²值	?	0.282	0.631	0.211	1.183	0.983	0.829
P值	?	0.781	0.535	0.835	0.251	0.337	0.704

组别	例数	年龄（岁）	性别比（例，男/女）	APACHEⅡ评分（分）	体外循环时间（min）	机械通气时间（h）	住ICU时间（d）
容量反应阳性组	16	64 ± 8	10/6	11.6 ± 2.7	52 ± 32	11 ± 5	1.8 ± 1.0
容量反应阴性组	6	69 ± 6	3/3	12.7 ± 2.4	68 ± 34	12 ± 6	1.7 ± 0.5
t/χ²值	?	0.282	0.631	0.211	1.183	0.983	0.829
P值	?	0.781	0.535	0.835	0.251	0.337	0.704

组别	例数	心率（次/min）	收缩压（mmHg）	舒张压（mmHg）	中心静脉压（cmH₂O）	肺动脉楔压（cmH₂O）
容量反应阳性组	16	81.4 ± 10.3	110.0 ± 12.2	58.5 ± 8.6	5.2 ± 2.2	6.7 ± 3.1
容量反应阴性组	6	81.7 ± 9.4	113.5 ± 12.3	59.4 ± 8.5	5.8 ± 1.9	6.6 ± 2.4
t值	?	0.135	1.172	0.437	1.138	0.116
P值	?	0.893	0.245	0.664	0.192	0.908
组别	例数	心输出量（L/min）	EDVI（mL/m²）	每搏输出量（mL）	IVCmax（cm）	IVCmin（cm）	IVCV（%）
容量反应阳性组	16	4.5 ± 0.8	104 ± 14	56 ± 9	2.06 ± 0.37	1.61 ± 0.28	21 ± 7
容量反应阴性组	6	5.0 ± 0.8	107 ± 19	62 ± 11	2.10 ± 0.28	1.91 ± 0.29	9±3
t值	?	2.586	0.699	2.236	0.538	4.217	9.242
P值	?	0.012	0.487	0.021	0.593	<0.001	<0.001

组别	例数	心率（次/min）	收缩压（mmHg）	舒张压（mmHg）	中心静脉压（cmH₂O）	肺动脉楔压（cmH₂O）
容量反应阳性组	16	81.4 ± 10.3	110.0 ± 12.2	58.5 ± 8.6	5.2 ± 2.2	6.7 ± 3.1
容量反应阴性组	6	81.7 ± 9.4	113.5 ± 12.3	59.4 ± 8.5	5.8 ± 1.9	6.6 ± 2.4
t值	?	0.135	1.172	0.437	1.138	0.116
P值	?	0.893	0.245	0.664	0.192	0.908
组别	例数	心输出量（L/min）	EDVI（mL/m²）	每搏输出量（mL）	IVCmax（cm）	IVCmin（cm）	IVCV（%）
容量反应阳性组	16	4.5 ± 0.8	104 ± 14	56 ± 9	2.06 ± 0.37	1.61 ± 0.28	21 ± 7
容量反应阴性组	6	5.0 ± 0.8	107 ± 19	62 ± 11	2.10 ± 0.28	1.91 ± 0.29	9±3
t值	?	2.586	0.699	2.236	0.538	4.217	9.242
P值	?	0.012	0.487	0.021	0.593	<0.001	<0.001

?	临界值	特异性（%）	灵敏度（%）	曲线下面积	95%置信区间		P值
?	临界值	特异性（%）	灵敏度（%）	曲线下面积	下限	上限	P值
中心静脉压（mmHg）	8.5	86.2	8.1	0.392	0.256	0.529	0.136
肺动脉楔压（cmH₂O）	11.5	96.6	8.1	0.485	0.344	0.625	0.831
EDVI（mL/m²）	82.5	13.8	91.9	0.442	0.299	0.586	0.423
IVCV（%）	14.05	86.2	91.9	0.941	0.879	1.000	<0.001

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