Cite this post as:
Scott Weingart, MD FCCM. The IVC for Fluid Assessment Roundup. EMCrit Blog. Published on November 23, 2013. Accessed on April 26th 2024. Available at [https://emcrit.org/emcrit/ivc-roundup/ ].
Financial Disclosures:
Dr. Scott Weingart, Course Director, reports no relevant financial relationships with ineligible companies.
This episode’s speaker(s), (listed above), report no relevant financial relationships with ineligible companies.
CME Review
Original Release: November 23, 2013
Date of Most Recent Review: Jan 1, 2022
Termination Date: Jan 1, 2025
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Thanks a lot Scott, this is the best review and debate about the IVC for the evaluation of fluid responsiveness I’ve ever read. I agree that a quick look to the IVC gives precious information, really very easy and rapid to achieve, but, as it had been outlined in the review of Bodson and Weillard Baron (Critical Care 2012, 16:181), we have to be aware that the IVC collapsibility index is strongly influenced by the swings of intrathoracic pressure. So in patients with dyspnea and strong inspiratory efforts we have to be careful in evaluating the meaning of a collapsing… Read more »
Hi Scott, Thanks for tackling this difficult topic. I just want to put in a couple of cents on personal experience with using bedside LVOT VTI clinically. You mention that accuracy is a noted issue but that this limitation doesn’t apply to using serial measurements. However, my experience is that there is a potentially even greater issue with precision, i.e. reproducibility even in the hands of a single examiner UNLESS (potentially) you are really taking the hard-core multiple view, multiple sample approach employed by studies like Brouchard’s. You allude to the limitations of positioning and cardiac cycle changes with respiratory… Read more »
Dustin, Fantastic comment. I have given up on VTI for actual usability vs. theoretical fun. The reproducibility issue you raise is just one of many reasons it is not feasible. It also takes too long. But I think the question of fluid responsiveness is vital. Not to encourage a continued resus until the pt is not fluid responsive, but rather the opposite. It is needed for this situation: “Hey doc, his MAP is a little soft and his UOP is down” You may be tempted to give a liter. But if you had a reliable bedside monitor of stroke volume,… Read more »
Thanks Scott, totally agree with you there and so I see the utility of such monitoring to really be beyond the 12th post-op or post-admission hour, but not during an acute resuscitation as it seems to have been advocated. II think it is pretty hard to have gone truly too far during an acute resus without first coming across some other sign (pulmonary edema, JVD/sky high CVP, terrible systolic function on a bedside echo) indicating that you need to change strategies in order to meet your endpoint targets, be it lactate clearance, ScvO2 normalization or a pleasant toe temperature. One… Read more »
Hi Scott, thanks for all your interesting analyses on your blog, great reads! I understand in spontaneously breathing patients, changes in intra-thoracic pressures are more much unpredictable than in MVP’s, this partly explains why IVC CI is a much better predictor of fluid responsiveness in the latter context. However, I don’t understand why an IVC CI of ~12-16% is the threshold IVC CI in MVP but is is a much larger 40-42% in SBP’s? Why is the IVC CI threshold for predicting responsiveness so much smaller in MVP’s? I was hoping you could maybe explain it very simply or refer… Read more »