Subclavian Vein Collapsibility as a Predictor of Fluid Responsiveness in
Spontaneously Breathing Hypotensive Patients

Manjit      Mahendran; Arvind      Kumar; Smriti      Hari; Mohd      Usman; Maroof      Ahmad Khan; Piyush      Ranjan; Manish      Soneja; Naval   K.   Vikram; Ashutosh      Biswas; Praveen      Aggarwal; Naveet      Wig

doi:10.2174/04666230328094312

Abstract

Background and Objective: Volume replacement remains the cornerstone of resuscitation in critically ill patients. This study explored the ability of the subclavian vein collapsibility index to predict fluid responsiveness.

Methods: In this prospective observational study conducted in the Department of Medicine, All India Institute of Medical Sciences (AIIMS), New Delhi, sonographic evaluation of inferior vena cava and the right subclavian vein was carried out at three time points for hypotensive patients admitted to the emergency department. The study population was divided into two groups: responders and non-responders, based on a ≥ 15% increase in stroke volume following fluid bolus.

Results: Among 45 recruited patients, 33 patients were responders. The area under the ROC curve for SCV CI at baseline to predict fluid responsiveness was 0.745 (95% confidence interval: 0.549 – 0.941; p = 0.014). An SCV-CI of 46% predicted fluid responsiveness in a hypotensive patient in terms of change in stroke volume by 15% following fluid bolus with a sensitivity of 87.88% (95% confidence interval: 71.80% to 96.60%) and specificity of 66.67% (95% confidence interval: 34.89% to 90.08%). Spearman’s correlation coefficient between IVC CI and SCV CI was 0.59 (p < 0.001, n = 135).

Conclusion: The results of the study demonstrated that right subclavian vein respiratory variation has the ability to predict fluid responsiveness in a spontaneously breathing patient in circulatory shock and correlates with the inferior vena cava collapsibility index. The subclavian vein can be an alternative to the inferior vena cava in predicting fluid responsiveness in spontaneously breathing patients.

Keywords: Subclavian vein, Fluid responsiveness, Circulatory shock, Spontaneous breathing, Vena Cava, Subclavian vein.

[1]
Michard F, Teboul JL. Predicting fluid responsiveness in ICU patients: A critical analysis of the evidence. Chest  2002; 121(6): 2000-8.
 [http://dx.doi.org/10.1378/chest.121.6.2000] [PMID: 12065368]

[2]
Marik PE, Monnet X, Teboul JL. Hemodynamic parameters to guide fluid therapy. Ann Intensive Care  2011; 1(1): 1-9.
 [http://dx.doi.org/10.1186/2110-5820-1-1] [PMID: 21906322]

[3]
Boyd JH, Forbes J, Nakada T, Walley KR, Russell JA. Fluid resuscitation in septic shock: A positive fluid balance and elevated central venous pressure are associated with increased mortality. Crit Care Med  2011; 39(2): 259-65.
 [http://dx.doi.org/10.1097/CCM.0b013e3181feeb15] [PMID: 20975548]

[4]
Yildirimturk O, Tayyareci Y, Erdim R, et al. Assessment of right atrial pressure using echocardiography and correlation with catheterization. J Clin Ultrasound  2011; 39(6): 337-43.
 [http://dx.doi.org/10.1002/jcu.20837] [PMID: 21544830]

[5]
Iberti TJ, Benjamin E, Gruppi L, Raskin JM. Ventricular arrhythmias during pulmonary artery catheterization in the intensive care unit prospective study. Am J Med  1985; 78(3): 451-4.
 [http://dx.doi.org/10.1016/0002-9343(85)90337-7] [PMID: 3976703]

[6]
Evans DC, Doraiswamy VA, Prosciak MP, et al. Complications associated with pulmonary artery catheters: A comprehensive clinical review. Scand J Surg  2009; 98(4): 199-208.
 [http://dx.doi.org/10.1177/145749690909800402] [PMID: 20218415]

[7]
Nagi AI, Shafik AM, Fatah AMA, Selima WZ, Hefny AF. Inferior vena cava collapsibility index as a predictor of fluid responsiveness in sepsis-related acute circulatory failure. Ain-Shams J Anesthesiol  2021; 13 (1).
 [http://dx.doi.org/10.1186/s42077-021-00194-y]

[8]
Levitov A, Frankel HL, Blaivas M, et al. Guidelines for the appropriate use of bedside general and cardiac ultrasonography in the evaluation of critically ill patients - Part II: Cardiac ultrasonography. Crit Care Med  2016; 44(6): 1206-27.
 [http://dx.doi.org/10.1097/CCM.0000000000001847] [PMID: 27182849]

[9]
Das SK, Choupoo NS, Pradhan D, Saikia P, Monnet X. Diagnostic accuracy of inferior vena caval respiratory variation in detecting fluid unresponsiveness. Eur J Anaesthesiol  2018; 35(11): 831-9.
 [http://dx.doi.org/10.1097/EJA.0000000000000841] [PMID: 29901465]

[10]
Orso D, Paoli I, Piani T, Cilenti FL, Cristiani L, Guglielmo N. Accuracy of ultrasonographic measurements of inferior vena cava to determine fluid responsiveness: A systematic review and meta-analysis. J Intensive Care Med  2020; 35(4): 354-63.
 [http://dx.doi.org/10.1177/0885066617752308] [PMID: 29343170]

[11]
Kimura BJ, Dalugdugan R, Gilcrease GW III, Phan JN, Showalter BK, Wolfson T. The effect of breathing manner on inferior vena caval diameter. Eur J Echocardiogr  2011; 12(2): 120-3.
 [http://dx.doi.org/10.1093/ejechocard/jeq157] [PMID: 20980326]

[12]
Muller L, Bobbia X, Toumi M, et al. Respiratory variations of inferior vena cava diameter to predict fluid responsiveness in spontaneously breathing patients with acute circulatory failure: Need for a cautious use. Crit Care  2012; 16(5): R188.
 [http://dx.doi.org/10.1186/cc11672] [PMID: 23043910]

[13]
Dipti A, Soucy Z, Surana A, Chandra S. Role of inferior vena cava diameter in assessment of volume status: A meta-analysis. Am J Emerg Med  2012; 30(8): 1414-1419.e1.
 [http://dx.doi.org/10.1016/j.ajem.2011.10.017] [PMID: 22221934]

[14]
Corl KA, George NR, Romanoff J, et al. Inferior vena cava collapsibility detects fluid responsiveness among spontaneously breathing critically-ill patients. J Crit Care  2017; 41: 130-7.
 [http://dx.doi.org/10.1016/j.jcrc.2017.05.008] [PMID: 28525778]

[15]
Corl K, Napoli AM, Gardiner F. Bedside sonographic measurement of the inferior vena cava caval index is a poor predictor of fluid responsiveness in emergency department patients. Emerg Med Australas  2012; 24(5): 534-9.
 [http://dx.doi.org/10.1111/j.1742-6723.2012.01596.x] [PMID: 23039295]

[16]
Airapetian N, Maizel J, Alyamani O, et al. Does inferior vena cava respiratory variability predict fluid responsiveness in spontaneously breathing patients? Crit Care  2015; 19(1): 400.
 [http://dx.doi.org/10.1186/s13054-015-1100-9] [PMID: 26563768]

[17]
Kent A, Bahner DP, Boulger CT, et al. Sonographic evaluation of intravascular volume status in the surgical intensive care unit: A prospective comparison of subclavian vein and inferior vena cava collapsibility index. J Surg Res  2013; 184(1): 561-6.
 [http://dx.doi.org/10.1016/j.jss.2013.05.040] [PMID: 23764308]

[18]
Kent A, Patil P, Davila V, et al. Sonographic evaluation of intravascular volume status: Can internal jugular or femoral vein collapsibility be used in the absence of IVC visualization? Ann Thorac Med  2015; 10(1): 44-9.
 [PMID: 25593607]

[19]
Wallace DJ, Allison M, Stone MB. Inferior vena cava percentage collapse during respiration is affected by the sampling location: An ultrasound study in healthy volunteers. Acad Emerg Med  2010; 17(1): 96-9.
 [http://dx.doi.org/10.1111/j.1553-2712.2009.00627.x] [PMID: 20003120]

[20]
Zhu P, Zhang X, Luan H, et al. Ultrasonographic measurement of the subclavian vein diameter for assessment of intravascular volume status in patients undergoing gastrointestinal surgery: Comparison with central venous pressure. J Surg Res  2015; 196(1): 102-6.
 [http://dx.doi.org/10.1016/j.jss.2015.02.063] [PMID: 25818975]

[21]
Giraud R, Abraham PS, Brindel P, Siegenthaler N, Bendjelid K. Respiratory changes in subclavian vein diameters predicts fluid responsiveness in intensive care patients: A pilot study. J Clin Monit Comput  2018; 32(6): 1049-55.
 [http://dx.doi.org/10.1007/s10877-018-0103-x] [PMID: 29380189]

[22]
Long E, Oakley E, Duke T, Babl FE. Does respiratory variation in inferior vena cava diameter predict fluid responsiveness. Shock  2017; 47(5): 550-9.
 [http://dx.doi.org/10.1097/SHK.0000000000000801] [PMID: 28410544]

[23]
Zhang Z, Lu B, Sheng X, Jin N. Accuracy of stroke volume variation in predicting fluid responsiveness: A systematic review and meta-analysis. J Anesth  2011; 25(6): 904-16.
 [http://dx.doi.org/10.1007/s00540-011-1217-1] [PMID: 21892779]

[24]
Correlation coefficients: Appropriate use and interpretation. Anesthesia & Analgesia  2018; 126(5): 1763-8.
 [http://dx.doi.org/10.1213/ANE.0000000000002864]