Valk, S. de (Silke) (2012) De respiratoire variatie in diameter van de vena cava inferior als voorspeller van. thesis, Medicine.
Full text available on request.Abstract
Background: Fluid therapy is considered to be the first step in the resuscitation of hemodynamic instable patients with signs of shock in the emergency department. However not all types of shock are caused by a decrease in intravascular volume, as a result not every patient with signs of shock is volume responsive. Uncorrected hypovolemia as well as excess fluid resuscitation are associated with increased complications. In the emergency department the physicians have to make an estimation of the intravascular volume status before invasive monitoring is available. Therefore, a non-invasive parameter to predict fluid responsiveness would be of great value. The objective of this study is to investigate whether the respiratory variation of the inferior vena cava (expressed as the ‘caval index’; a high caval index is associated with a decrease in intravascular volume) is a reliable parameter to predict fluid responsiveness in emergency department patients with signs of shock. Methods: During 15 weeks all patients in the emergency department of the University Medical Centre Groningen (UMCG), who were registered to be assessed by an internist or emergency physician, were screened for signs of shock. Patients with one or more signs of shock were included in the study when the attending physician decided to start with fluid resuscitation of at least 500 ml Sodium Chloride 0.9%. Before the fluid therapy was started, the caval index was determined in supine position and again during the passive leg raising manoeuvre. Then the response to fluid therapy was observed during one hour. An adequate response to fluid therapy was defined as an increase in systolic blood pressure of at least 10 mmHg. Based on this definition patients were divided into two groups; one group of responders and one group of non-responders. Results: Responders had a significantly higher caval index compared to non-responders (48.7% and compared to 31.8%, p=0.014). Independently from the division in responders and non-responders there was only a weak correlation between the caval index and the response to fluid therapy (r=0.259). In this study population the most optimal cut-off value for the caval index was 36.5%. Based on this threshold value the caval index predicts fluid responsiveness with 83% sensitivity, 67% specificity, a positive predictive value of 48% and a negative predictive value of 92%. Conclusion: A caval index of < 36.5% in a patient with signs of shock predicts with a reliability of 92% the absence of an adequate response to fluid therapy. However, based on the findings of this study it is not possible to predict the response to fluid therapy for a patient with a caval index of > 36.5%. Perhaps the positive predictive value of the caval index to predict fluid responsiveness is negatively affected by the fact that the definition of adequate response (increase in systolic blood pressure of at least 10 mmHg) is not suitable for patients with a severe decrease in intravascular volume.
| Item Type: | Thesis (Thesis) |
|---|---|
| Supervisor name: | Begeleider: and Olgers, T.J. and internist-acuut geneeskundige and Spoedeisende hulp, UMCG |
| Faculty: | Medical Sciences |
| Date Deposited: | 25 Jun 2020 11:05 |
| Last Modified: | 25 Jun 2020 11:05 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/2464 |
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