Does inferior vena cava respiratory variability predict fluid responsiveness in spontaneously breathing patients?

Introduction: We have almost no information concerning the value of inferior vena cava (IVC) respiratory variations in spontaneously breathing ICU patients (SBP) to predict fluid responsiveness. Methods: SBP with clinical fluid need were included prospectively in the study. Echocardiography and Doppler ultrasound were used to record the aortic velocity-time integral (VTI), stroke volume (SV), cardiac output (CO) and IVC collapsibility index (cIVC) ((maximum diameter (IVCmax)-minimum diameter (IVCmin))/IVCmax) at baseline, after a passive leg-raising maneuver (PLR) and after 500 ml of saline infusion. Results: Fifty-nine patients (30 males and 29 females; 57 +/- 18 years-old) were included in the study. Of these, 29 (49 %) were considered to be responders (>= 10 % increase in CO after fluid infusion). There were no significant differences between responders and nonresponders at baseline, except for a higher aortic VTI in nonresponders (16 cm vs. 19 cm, p = 0.03). Responders had a lower baseline IVCmin than nonresponders (11 +/- 5 mm vs. 14 +/- 5 mm, p = 0.04) and more marked IVC variations (cIVC: 35 +/- 16 vs. 27 +/- 10 %, p = 0.04). Prediction of fluid-responsiveness using cIVC and IVCmax was low (area under the curve for cIVC at baseline 0.62 +/- 0.07; 95 %, CI 0.49-0.74 and for IVCmax at baseline 0.62 +/- 0.07; 95 % CI 0.49-0.75). In contrast, IVC respiratory variations >42 % in SBP demonstrated a high specificity (97 %) and a positive predictive value (90 %) to predict an increase in CO after fluid infusion. Conclusions: In SBP with suspected hypovolemia, vena cava size and respiratory variability do not predict fluid responsiveness. In contrast, a cIVC >42 % may predict an increase in CO after fluid infusion.