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Inferior Vena Cava Collapsibility Index Versus Passive Leg Raise To Assess Fluid Responsiveness in Non-Intubated Septic Patients - A Prospective Observational Study

Received: 17 August 2023     Accepted: 13 September 2023     Published: 25 September 2023
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Abstract

Background: Rapid fluid loading at diagnosis of sepsis is part of standard treatment. Predictive tools of fluid responsiveness are required to guide fluid resuscitation. The Passive Leg Raise [PLR] manoeuvre can predict fluid responsiveness in non-intubated patients with sepsis. The Inferior Vena Cava Collapsibility Index [IVCCI] can also be utilised but is not routinely performed. Aim: To investigate the correlation between Inferior Vena Cava Collapsibility Index [IVCCI] and a Passive Leg Raise [PLR] manoeuvre for the assessment of fluid responsiveness in non-intubated septic patients in a tertiary referral hospital in Sub-Saharan Africa. Methodology: A prospective observational study which recruited non-intubated septic patients who were hypotensive [mean arterial pressure less than 65 mm Hg], requiring fluid resuscitation. Focused Cardiac Ultrasound [FoCUS] was used to measure IVCCI followed immediately by a PLR manoeuvre for comparison. Patients were classified as fluid responders if they had an IVCCI ≥ 50% and/or an increase of 10% in pulse pressure following a PLR. The correlation between IVCCI and PLR on each patient in predicting fluid responsiveness was then assessed. Results: 38 patients satisfied the inclusion criteria. McNemar’s test yielded a p=0.039 indicating that PLR test and IVCCI are not equivalent in predicting fluid responsiveness in non-intubated septic patients. A Cohen’s Kappa of 0.283 signified only a “fair” correlation between the two. An IVCCI cut-off of 30% would have resulted in a near- perfect agreement as evidenced by a Cohen’s Kappa value of 0.93. A cut off between 30-40% would give a Cohen’ Kappa of 0.81 with a strong level of agreement. Conclusion: The PLR test and IVCCI test have a fair correlation and are not identical in predicting fluid responsiveness in non-intubated spontaneously breathing septic patients.

Published in International Journal of Anesthesia and Clinical Medicine (Volume 11, Issue 2)
DOI 10.11648/j.ijacm.20231102.17
Page(s) 88-97
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This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.

Copyright

Copyright © The Author(s), 2023. Published by Science Publishing Group

Keywords

Fluid Responsiveness, Passive Leg Raise Manoeuvre, Inferior Vena Cava Collapsibility Index, Focused Cardiac Ultrasound, Sepsis

References
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Cite This Article
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    Anne-Marie Githaiga, Wangari Waweru-Siika, Mohamed Jeilan, Idris Chikophe, Vitalis Mung’ayi. (2023). Inferior Vena Cava Collapsibility Index Versus Passive Leg Raise To Assess Fluid Responsiveness in Non-Intubated Septic Patients - A Prospective Observational Study. International Journal of Anesthesia and Clinical Medicine, 11(2), 88-97. https://doi.org/10.11648/j.ijacm.20231102.17

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    Anne-Marie Githaiga; Wangari Waweru-Siika; Mohamed Jeilan; Idris Chikophe; Vitalis Mung’ayi. Inferior Vena Cava Collapsibility Index Versus Passive Leg Raise To Assess Fluid Responsiveness in Non-Intubated Septic Patients - A Prospective Observational Study. Int. J. Anesth. Clin. Med. 2023, 11(2), 88-97. doi: 10.11648/j.ijacm.20231102.17

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    AMA Style

    Anne-Marie Githaiga, Wangari Waweru-Siika, Mohamed Jeilan, Idris Chikophe, Vitalis Mung’ayi. Inferior Vena Cava Collapsibility Index Versus Passive Leg Raise To Assess Fluid Responsiveness in Non-Intubated Septic Patients - A Prospective Observational Study. Int J Anesth Clin Med. 2023;11(2):88-97. doi: 10.11648/j.ijacm.20231102.17

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  • @article{10.11648/j.ijacm.20231102.17,
      author = {Anne-Marie Githaiga and Wangari Waweru-Siika and Mohamed Jeilan and Idris Chikophe and Vitalis Mung’ayi},
      title = {Inferior Vena Cava Collapsibility Index Versus Passive Leg Raise To Assess Fluid Responsiveness in Non-Intubated Septic Patients - A Prospective Observational Study},
      journal = {International Journal of Anesthesia and Clinical Medicine},
      volume = {11},
      number = {2},
      pages = {88-97},
      doi = {10.11648/j.ijacm.20231102.17},
      url = {https://doi.org/10.11648/j.ijacm.20231102.17},
      eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ijacm.20231102.17},
      abstract = {Background: Rapid fluid loading at diagnosis of sepsis is part of standard treatment. Predictive tools of fluid responsiveness are required to guide fluid resuscitation. The Passive Leg Raise [PLR] manoeuvre can predict fluid responsiveness in non-intubated patients with sepsis. The Inferior Vena Cava Collapsibility Index [IVCCI] can also be utilised but is not routinely performed. Aim: To investigate the correlation between Inferior Vena Cava Collapsibility Index [IVCCI] and a Passive Leg Raise [PLR] manoeuvre for the assessment of fluid responsiveness in non-intubated septic patients in a tertiary referral hospital in Sub-Saharan Africa. Methodology: A prospective observational study which recruited non-intubated septic patients who were hypotensive [mean arterial pressure less than 65 mm Hg], requiring fluid resuscitation. Focused Cardiac Ultrasound [FoCUS] was used to measure IVCCI followed immediately by a PLR manoeuvre for comparison. Patients were classified as fluid responders if they had an IVCCI ≥ 50% and/or an increase of 10% in pulse pressure following a PLR. The correlation between IVCCI and PLR on each patient in predicting fluid responsiveness was then assessed. Results: 38 patients satisfied the inclusion criteria. McNemar’s test yielded a p=0.039 indicating that PLR test and IVCCI are not equivalent in predicting fluid responsiveness in non-intubated septic patients. A Cohen’s Kappa of 0.283 signified only a “fair” correlation between the two. An IVCCI cut-off of 30% would have resulted in a near- perfect agreement as evidenced by a Cohen’s Kappa value of 0.93. A cut off between 30-40% would give a Cohen’ Kappa of 0.81 with a strong level of agreement. Conclusion: The PLR test and IVCCI test have a fair correlation and are not identical in predicting fluid responsiveness in non-intubated spontaneously breathing septic patients.},
     year = {2023}
    }
    

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  • TY  - JOUR
    T1  - Inferior Vena Cava Collapsibility Index Versus Passive Leg Raise To Assess Fluid Responsiveness in Non-Intubated Septic Patients - A Prospective Observational Study
    AU  - Anne-Marie Githaiga
    AU  - Wangari Waweru-Siika
    AU  - Mohamed Jeilan
    AU  - Idris Chikophe
    AU  - Vitalis Mung’ayi
    Y1  - 2023/09/25
    PY  - 2023
    N1  - https://doi.org/10.11648/j.ijacm.20231102.17
    DO  - 10.11648/j.ijacm.20231102.17
    T2  - International Journal of Anesthesia and Clinical Medicine
    JF  - International Journal of Anesthesia and Clinical Medicine
    JO  - International Journal of Anesthesia and Clinical Medicine
    SP  - 88
    EP  - 97
    PB  - Science Publishing Group
    SN  - 2997-2698
    UR  - https://doi.org/10.11648/j.ijacm.20231102.17
    AB  - Background: Rapid fluid loading at diagnosis of sepsis is part of standard treatment. Predictive tools of fluid responsiveness are required to guide fluid resuscitation. The Passive Leg Raise [PLR] manoeuvre can predict fluid responsiveness in non-intubated patients with sepsis. The Inferior Vena Cava Collapsibility Index [IVCCI] can also be utilised but is not routinely performed. Aim: To investigate the correlation between Inferior Vena Cava Collapsibility Index [IVCCI] and a Passive Leg Raise [PLR] manoeuvre for the assessment of fluid responsiveness in non-intubated septic patients in a tertiary referral hospital in Sub-Saharan Africa. Methodology: A prospective observational study which recruited non-intubated septic patients who were hypotensive [mean arterial pressure less than 65 mm Hg], requiring fluid resuscitation. Focused Cardiac Ultrasound [FoCUS] was used to measure IVCCI followed immediately by a PLR manoeuvre for comparison. Patients were classified as fluid responders if they had an IVCCI ≥ 50% and/or an increase of 10% in pulse pressure following a PLR. The correlation between IVCCI and PLR on each patient in predicting fluid responsiveness was then assessed. Results: 38 patients satisfied the inclusion criteria. McNemar’s test yielded a p=0.039 indicating that PLR test and IVCCI are not equivalent in predicting fluid responsiveness in non-intubated septic patients. A Cohen’s Kappa of 0.283 signified only a “fair” correlation between the two. An IVCCI cut-off of 30% would have resulted in a near- perfect agreement as evidenced by a Cohen’s Kappa value of 0.93. A cut off between 30-40% would give a Cohen’ Kappa of 0.81 with a strong level of agreement. Conclusion: The PLR test and IVCCI test have a fair correlation and are not identical in predicting fluid responsiveness in non-intubated spontaneously breathing septic patients.
    VL  - 11
    IS  - 2
    ER  - 

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Author Information
  • Department of Anaesthesiology, Aga Khan University Hospital, Nairobi, Kenya

  • Department of Anaesthesiology, Aga Khan University Hospital, Nairobi, Kenya

  • Department of Anaesthesiology, Aga Khan University Hospital, Nairobi, Kenya

  • Department of Anaesthesiology, Aga Khan University Hospital, Nairobi, Kenya

  • Department of Anaesthesiology, Aga Khan University Hospital, Nairobi, Kenya

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