Prediction of Intradialytic Hypotension by Respiratory Changes in Inferior Vena Cava Diameter and Passive Leg Raising Test in Patients with Renal Failure
Elkholy, M., Gaber, L., Eldehily, K., Sabry, S. (2024). Prediction of Intradialytic Hypotension by Respiratory Changes in Inferior Vena Cava Diameter and Passive Leg Raising Test in Patients with Renal Failure. EKB Journal Management System, 4(1), 51-65. doi: 10.21608/jicem.2024.244440.1025
Mohamed Bakry Elkholy; Lamiaa Kamel Gaber; Khalaf Ibrahim Eldehily; Sherif Medhat Sabry. "Prediction of Intradialytic Hypotension by Respiratory Changes in Inferior Vena Cava Diameter and Passive Leg Raising Test in Patients with Renal Failure". EKB Journal Management System, 4, 1, 2024, 51-65. doi: 10.21608/jicem.2024.244440.1025
Elkholy, M., Gaber, L., Eldehily, K., Sabry, S. (2024). 'Prediction of Intradialytic Hypotension by Respiratory Changes in Inferior Vena Cava Diameter and Passive Leg Raising Test in Patients with Renal Failure', EKB Journal Management System, 4(1), pp. 51-65. doi: 10.21608/jicem.2024.244440.1025
Elkholy, M., Gaber, L., Eldehily, K., Sabry, S. Prediction of Intradialytic Hypotension by Respiratory Changes in Inferior Vena Cava Diameter and Passive Leg Raising Test in Patients with Renal Failure. EKB Journal Management System, 2024; 4(1): 51-65. doi: 10.21608/jicem.2024.244440.1025

Prediction of Intradialytic Hypotension by Respiratory Changes in Inferior Vena Cava Diameter and Passive Leg Raising Test in Patients with Renal Failure

The Egyptian Journal of Intensive Care and Emergency Medicine
Volume 4, Issue 1, January 2024, Page 51-65  XML PDF (499.59 K)
Document Type: Original papers
DOI: 10.21608/jicem.2024.244440.1025
View on SCiNiTO View on SCiNiTO
Authors
Mohamed Bakry Elkholy; Lamiaa Kamel Gaber; Khalaf Ibrahim Eldehily; Sherif Medhat Sabry email
Critical Care Medicine Department, Faculty of Medicine, Beni-Suef University, Beni-Suef, Egypt
Abstract
Background: The incidence of intradialytic hypotension (IDH) is approximately 10-12% of treatments. Recurrent interruption of blood flow to vital organs in individuals with IDH may adversely affect the cardiovascular, central neurological, renal, and gastrointestinal systems[1].  Aim of the work : To investigate the ability to predict  hemodynamic intolerance to fluid removal by respiratory variations in IVC diameter and PLR test before intermittent renal replacement therapy.to Methods: This prospective cohort observational work was carried out on 40 individuals aged 18 years old or more, both sexes, with clinical criteria of acute kidney disease and sinus rhythm. Participants were categorized into two groups: group I:patients who didn’t develop IDH, and group II: patient who developed IDH.  Results: The IVC collapsibility and change in COP (cardiac output) were significantly greater in Group II (16 patients) contrasted to Group I (24 patients). The ROC curve of predicted probability [COP response (>12.0%) and IVC collapsibility response (>50.0%)] is associated with intradialytic hypotension 0.775 (95% CI 0.624-0.926, P =0.004). Conclusions: COP response (>12.0%) and IVC collapsibility response (>50.0%) had a good predictive value of IDH.
Keywords
Intradialytic Hypotension; Inferior Vena Cava Diameter; Passive Leg Raising Test; Renal Failure; Respiratory Changes
References
 

  1. Kanbay M, Ertuglu LA, Afsar B, Ozdogan E, Siriopol D, Covic A, et al. An update review of intradialytic hypotension: concept, risk factors, clinical implications and management. Clin Kidney J. 2020;13:981-93.
  2. Sars B, van der Sande FM, Kooman JP. Intradialytic hypotension: Mechanisms and outcome. Blood Purif. 2020;49:158-67.
  3. Davenport A. Using dialysis machine technology to reduce intradialytic hypotension. Hemodial Int. 2011;15 37-42.
  4. Kaptein MJ, Kaptein JS, Nguyen CD, Oo Z, Thwe PP, Thu MB, et al. Changes in cardiac output with hemodialysis relate to net volume balance and to inferior vena cava ultrasound collapsibility in critically ill patients. Ren Fail. 2020;42:179-92.
  5. Porter TR, Shillcutt SK, Adams MS, Desjardins G, Glas KE, Olson JJ, et al. Guidelines for the use of echocardiography as a monitor for therapeutic intervention in adults: a report from the American Society of Echocardiography. J Am Soc Echocardiogr. 2015;28:40-56.
  6. Monnet X, Cipriani F, Camous L, Sentenac P, Dres M, Krastinova E, et al. The passive leg raising test to guide fluid removal in critically ill patients. Ann Intensive Care. 2016;6:46-50.
  7. Marik PE. Techniques for assessment of intravascular volume in critically ill patients. J Intensive Care Med. 2009;24:329-37.
  8. Via G, Tavazzi G, Price S. Ten situations where inferior vena cava ultrasound may fail to accurately predict fluid responsiveness: a physiologically based point of view. Intensive Care Med. 2016;42:1164-7.
  9. Weekes AJ, Tassone HM, Babcock A, Quirke DP, Norton HJ, Jayarama K, et al. Comparison of serial qualitative and quantitative assessments of caval index and left ventricular systolic function during early fluid resuscitation of hypotensive emergency department patients. Acad Emerg Med. 2011;18:912-21.
  10. Kaptein MJ, Kaptein EM. Focused real-time ultrasonography for nephrologists. Int J Nephrol. 2017;2017:3756-857.
  11. Kaptein MJ, Kaptein EM. Inferior vena cava collapsibility index: Clinical validation and application for assessment of relative intravascular volume. Adv Chronic Kidney Dis. 2021;28:218-26.
  12. da Hora Passos R, Caldas J, Ramos JGR, dos Santos Galvão de Melo EB, Ribeiro MPD, Alves MFC, et al. Ultrasound-based clinical profiles for predicting the risk of intradialytic hypotension in critically ill patients on intermittent dialysis: a prospective observational study. Critical Care. 2019;23:389.
  13. Kaptein MJ, Kaptein JS, Oo Z, Kaptein EM. Relationship of inferior vena cava collapsibility to ultrafiltration volume achieved in critically ill hemodialysis patients. Int J Nephrol Renovasc Dis. 2018;11:195-209.
  14. Purushothaman SS, Alex A, Kesavan R, Balakrishnan S, Rajan S, Kumar L. Ultrasound measurement of inferior vena cava collapsibility as a tool to predict propofol-induced hypotension. Anesth Essays Res. 2020;14:199-202.
  15. Jefferies HJ, Virk B, Schiller B, Moran J, McIntyre CW. Frequent hemodialysis schedules are associated with reduced levels of dialysis-induced cardiac injury (myocardial stunning). Clin J Am Soc Nephrol. 2011;6:1326-32.
  16. Rudski LG, Lai WW, Afilalo J, Hua L, Handschumacher MD, Chandrasekaran K, et al. Guidelines for the echocardiographic assessment of the right heart in adults: a report from the American Society of Echocardiography endorsed by the European Association of Echocardiography, a registered branch of the European Society of Cardiology, and the Canadian Society of Echocardiography. J Am Soc Echocardiogr. 2010;23:685- 788.
  17. Beigel R, Cercek B, Luo H, Siegel RJ. Noninvasive evaluation of right atrial pressure. J Am Soc Echocardiogr. 2013;26:1033-42.
  18. Corl KA, George NR, Romanoff J, Levinson AT, Chheng DB, Merchant RC, et al. Inferior vena cava collapsibility detects fluid responsiveness among spontaneously breathing critically-ill patients. J Crit Care. 2017;41:130-7.
  19. Si X, Cao D, Xu H, Guan X. Meta-analysis of ventilated versus spontaneously breathing patients in predicting fluid responsiveness by inferior vena cava variation. Int J Clin Med. 2018;9:760-77.
  20. Ismail MT, El-Iraky AA, Ibrahim EEA, El Kammash TH, Abou-Zied AE. Comparison of inferior vena cava collapsibility and central venous pressure in assessing volume status in shocked patients. Afr J Emerg Med. 2022;12:165-71.
  21. Pickett JD, Bridges E, Kritek PA, Whitney JD. Passive leg-raising and prediction of fluid responsiveness: Systematic review. Crit Care Nurse. 2017;37:32-47.
  22. Monnet X, Dres M, Ferré A, Le Teuff G, Jozwiak M, Bleibtreu A, et al. Prediction of fluid responsiveness by a continuous non-invasive assessment of arterial pressure in critically ill patients: comparison with four other dynamic indices. Br J Anaesth. 2012;109:330-8.
  23. Evans L, Rhodes A, Alhazzani W, Antonelli M, Coopersmith CM, French C, et al. Executive summary: Surviving sepsis campaign: International guidelines for the management of sepsis and septic shock 2021. Crit Care Med. 2021;49:1974-82.
Statistics
Article View: 32
PDF Download: 21