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

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dc.article.number46
dc.catalogadorpva
dc.contributor.authorBruna, Mario
dc.contributor.authorAlfaro, Sebastián
dc.contributor.authorMuñoz Ferrada, Felipe Ignacio
dc.contributor.authorCisternas, Liliana
dc.contributor.authorGonzález, Cecilia
dc.contributor.authorConlledo, Rodrigo
dc.contributor.authorUlloa Morrison, Rodrigo
dc.contributor.authorHuilcaman, Marcos
dc.contributor.authorRetamal, Jaime
dc.contributor.authorCastro López, Ricardo
dc.contributor.authorRola, Philippe
dc.contributor.authorWong, Adrian
dc.contributor.authorArgaiz, Eduardo R.
dc.contributor.authorContreras, Roberto
dc.contributor.authorHernández P., Glenn
dc.contributor.authorKattan Tala, Eduardo José
dc.date.accessioned2024-05-13T16:22:27Z
dc.date.available2024-05-13T16:22:27Z
dc.date.issued2024
dc.date.updated2024-05-12T00:04:30Z
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.
dc.fechaingreso.objetodigital2024-05-12
dc.fuente.origenAutoarchivo
dc.identifier.citationIntensive Care Medicine Experimental. 2024 May 08;12(1):46
dc.identifier.doi10.1186/s40635-024-00631-w
dc.identifier.urihttps://doi.org/10.1186/s40635-024-00631-w
dc.identifier.urihttps://repositorio.uc.cl/handle/11534/85571
dc.information.autorucEscuela de Medicina; Muñoz Ferrada, Felipe Ignacio; 0009-0006-9232-840X; 234428
dc.information.autorucEscuela de Medicina; González, Cecilia; 0000-0002-7327-8287; 247611
dc.information.autorucEscuela de Medicina; Retamal, Jaime; 0000-0002-6817-3659; 175147
dc.information.autorucEscuela de Medicina; Castro López, Ricardo; 0000-0002-0978-9891; 4537
dc.information.autorucEscuela de Medicina; Hernández P., Glenn; 0000-0002-3032-4087; 98874
dc.information.autorucEscuela de Medicina; Kattan Tala, Eduardo José; 0000-0002-1997-6893; 172152
dc.language.isoen
dc.nota.accesocontenido completo
dc.pagina.final9
dc.pagina.inicio1
dc.revistaIntensive Care Medicine Experimental
dc.rightsacceso abierto
dc.rights.holderThe Author(s)
dc.subjectPassive leg raising
dc.subjectHepatic vein Doppler
dc.subjectPreload responsiveness tests
dc.subjectShock
dc.subject.ddc610
dc.subject.deweyMedicina y saludes_ES
dc.subject.ods03 Good health and well-being
dc.subject.odspa03 Salud y bienestar
dc.titleDynamic changes of hepatic vein Doppler velocities predict preload responsiveness in mechanically ventilated critically ill patients
dc.typeartículo
dc.volumen12
sipa.codpersvinculados234428
sipa.codpersvinculados247611
sipa.codpersvinculados175147
sipa.codpersvinculados4537
sipa.codpersvinculados98874
sipa.codpersvinculados172152
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