Critical Care |

Does the Inferior Vena Cava Size (IVC) Assessment Help in the Management of Acute Kidney Injury (AKI) in Critically Ill Patients? FREE TO VIEW

Rami Jambeih, MD; Jean Keddissi, MD; Houssein Youness, MD
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Oklahoma University, Oklahoma City, OK

Chest. 2014;146(4_MeetingAbstracts):220A. doi:10.1378/chest.1994686
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SESSION TITLE: Non Pulmonary Critical Care Posters

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 29, 2014 at 01:30 PM - 02:30 PM

PURPOSE: To determine if ultrasonographic assessment of the IVC can guide the treatment of patients with AKI.

METHODS: Consecutive patients presenting to the ICU with a diagnosis of AKI (1.5 fold increase in plasma Creatinine level compared to baseline) were recruited. Exclusion criteria include dialysis, pulmonary emboli and obstructive uropathy. IVC size was measured during inspiration and expiration using the Sonosite probe P-21 (5-1 MHZ). For spontaneously breathing patients The IVC collapsibility index was calculated for (IVC-CI= [IVC max-IVCmin]/IVC max) , the IVC variation index (ΔIVC= IVC max-IVC min/mean diameter) was calculated for patients on mechanical ventilation. A cutoff of 50% for the IVC-CI and 12% for the ΔIVC were used to define fluid responsiveness. The decision of fluid administration or diuresis was left at the discretion of the primary team who was blinded to the results of the IVC measurements. Fluid balance as well as the change in plasma Creatinine level at 48 hours post admission was recorded Two groups of patients were identified. Group 1 includes the patients who were managed in concordance with their IVC measurements (Volume responders who had a positive fluid balance at 48 h post admission and volume non responders who had a negative fluid balance at 48 hours post admission), Group 2 includes the patients in whom the fluid management was discordant with the IVC measurement. Primary outcome was the percentage of patients with improved Creatinine level at 48 hour in group 1 and 2.

RESULTS: 11 patients were recruited (the study is still ongoing). Creatinine improved in 86%(6/7) of group 1 patients worsened in 100%(4/4) of group 2 patients (P =0.0125).The Mean change in creatinine level was -0.43±0.4 in group 1 and 0.42±0.48 in group 2 ( P=0.0125).

CONCLUSIONS: In critically ill patients, measurement of IVC-CI and ΔIVC can be used to guide fluid management of patients with AKI.

CLINICAL IMPLICATIONS: Ultrasonography evaluation of the IVC is a simple and effective tool in steering the decision between diuresis or fluid therapy for AKI.

DISCLOSURE: The following authors have nothing to disclose: Rami Jambeih, Jean Keddissi, Houssein Youness

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