Does inferior vena cava distensibility index correlate with inferior vena cava distensibility index in the assessment of intravascular volume in children undergoing urologic surgery?
Beliz Bilgili1, Murat Haliloğlu1, Halil Tuğtepe2, Tümay Umuroğlu1
1Marmara University, School of Medicine, Department of Anesthesiology
2Marmara University, School of Medicine, Department of Pediatric Surgery
BACKGROUND: The inferior vena cava distensibility index(IVC-DI) is validated for fluid responsiveness(FR) in mechanically ventilated adult patients but there is little data on it’s utility in children. The aim is to assess the predictive value of IVC-DI for FR in pediatric surgical patients and to evaluate the correlation between the distensibility indexes of inferior vena cava(IVC-DI) and internal jugular vein(IJV-DI). METHOD: After the approval of the ethical comity(MU,IDNo:09.2015.344)24 pediatric patients under general anesthesia were enrolled in the study. Following the anesthesia induction, mechanical ventilation was initiated with 8 ml/kg tidal volume. The study protocol was performed in two sequential stages. Baseline parameters(Stage 1) were recorded with the patient in the semi-recumbent position. Next, the passive leg raising(PLR) maneuver was carried, after 1 minute(Stage 2), a second measurement was recorded. In every stage, cardiac index, distensibility indexes of IVC and IJV were measured. Heart rate, mean arterial pressure(MAP) and end-tidal carbon dioxide(EtCO2) concentration values were recorded. An increase of >10% cardiac index induced by PLR, patients were considered to be responders(R), otherwise non-responders(NR). RESULTS: There were 16 responders and 8 non-responders. R had higher IVC-DI and IVJ-DI than NR in stage 1(p<0.001, p<0.001). In stage 2, IVC-DI and IJV-DI were similar between the groups(p=0.164, p=0.201). A cut-off value of >22.73 %, with the area under the receiver operating characteristic(ROC) curve(AUC) of 1.000(95%CI: 0.858-1.000, p<0.001) was determined for IVC-DI. A cut-off value of >24.99 %, the area under ROC curve of 1.000 (95%CI: 0.858-1.000, p<0.001) was determined for IJV-DI. IVC-DI and IJV-DI were positively correlated both in R and NR with a correlation coefficient of 0.626 and 0.929,respectively. CONCLUSION: The IVC-DI predicts fluid responsiveness in pediatric patients under general anesthesia. The IJV-DI correlates well with the IVC-DI and can be used as a prediction marker of fluid responsiveness in children.
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