PMID- 20094880
OWN - NLM
STAT- MEDLINE
DCOM- 20100610
LR  - 20220318
IS  - 1432-1238 (Electronic)
IS  - 0342-4642 (Linking)
VI  - 36
IP  - 4
DP  - 2010 Apr
TI  - Inferior vena cava collapsibility to guide fluid removal in slow continuous 
      ultrafiltration: a pilot study.
PG  - 692-6
LID - 10.1007/s00134-009-1745-4 [doi]
AB  - OBJECTIVE: To investigate whether ultrasound determination of the inferior vena 
      cava diameter (IVCD) and its collapsibility index (IVCCI) could be used to 
      optimize the fluid removal rate while avoiding hypotension during slow continuous 
      ultrafiltration (SCUF). METHODS: Twenty-four consecutive patients [13 men and 11 
      women, mean age 72 +/- 5 years; New York Heart Association (NYHA) functional 
      classes III-IV] with acute decompensated heart failure (ADHF) and diuretic 
      resistance were admitted to our 16-bed medical ICU. Blood pressure (BP), heart 
      rate (HR), respiratory rate (RR), blood samples for hematocrit, creatinine, 
      sodium, potassium, and arterial BGA plus lactate were obtained at baseline and 
      than every 2 h from the beginning of SCUF. IVCD, assessed by M-mode subcostal 
      echocardiography during spontaneous breathing, was evaluated before SCUF, at 12 
      h, and just after the cessation of the procedure. The IVCCI was calculated as 
      follows: [(IVCD(max) - IVCD(min))/IVCD(max)] x 100. RESULTS: Mean UF time was 
      20.3 +/- 4.6 h with a mean volume of 287.6 +/- 96.2 ml h(-1) and a total 
      ultrafiltrate production of 5,780.8 +/- 1,994.6 ml. No significant difference in 
      MAP, HR, RR, and IVCD before and after UF was found. IVCCI increased 
      significantly after UF (P < 0.001). Hypotension was observed only in those 
      patients (2/24) who reached an IVCCI >30%. In all the other patients, a 
      significant increase in IVCCI was obtained without any hemodynamic instability. 
      CONCLUSION: IVC ultrasound is a rapid, simple, and non-invasive means for bedside 
      monitoring of intravascular volume during SCUF and may guide fluid removal 
      velocity.
FAU - Guiotto, Giovanna
AU  - Guiotto G
AD  - Medical High Dependency Unit, San Paolo Hospital, Naples, Italy. 
      giovannaguiotto@fastwebnet.it
FAU - Masarone, Mario
AU  - Masarone M
FAU - Paladino, Fiorella
AU  - Paladino F
FAU - Ruggiero, Enrico
AU  - Ruggiero E
FAU - Scott, Sean
AU  - Scott S
FAU - Verde, Sossio
AU  - Verde S
FAU - Schiraldi, Fernando
AU  - Schiraldi F
LA  - eng
PT  - Journal Article
DEP - 20100122
PL  - United States
TA  - Intensive Care Med
JT  - Intensive care medicine
JID - 7704851
RN  - 0 (Diuretics)
SB  - IM
MH  - Aged
MH  - Blood Chemical Analysis
MH  - Blood Pressure/physiology
MH  - Diuretics/therapeutic use
MH  - Echocardiography
MH  - Female
MH  - Heart Failure/diagnostic imaging/physiopathology/*therapy
MH  - Heart Rate/physiology
MH  - Hemofiltration/*methods
MH  - Humans
MH  - Hypotension/*prevention & control
MH  - Male
MH  - Pilot Projects
MH  - Prospective Studies
MH  - ROC Curve
MH  - Respiratory Mechanics/physiology
MH  - Statistics, Nonparametric
MH  - Vena Cava, Inferior/*diagnostic imaging
EDAT- 2010/01/23 06:00
MHDA- 2010/06/11 06:00
CRDT- 2010/01/23 06:00
PHST- 2009/07/23 00:00 [received]
PHST- 2009/12/24 00:00 [accepted]
PHST- 2010/01/23 06:00 [entrez]
PHST- 2010/01/23 06:00 [pubmed]
PHST- 2010/06/11 06:00 [medline]
AID - 10.1007/s00134-009-1745-4 [doi]
PST - ppublish
SO  - Intensive Care Med. 2010 Apr;36(4):692-6. doi: 10.1007/s00134-009-1745-4. Epub 
      2010 Jan 22.