Can ultrasonographic measurement of respiratory variability in the diameter of the internal jugular vein and the subclavian vein predict fluid responsiveness in parturients during cesarean delivery? A prospective cohort study.

BACKGROUND

Ultrasonic measurements of the respiratory variability in the diameter of internal jugular vein (IJV-CI) and subclavian vein (SCV-CI) have recently been reported to be useful in predicting fluid responses in non-obstetric patients with spontaneous respiration. This study evaluated whether IJV-CI and SCV-CI could reliably predict fluid responsiveness in parturients undergoing elective cesarean delivery.

OBJECTIVE

This study was conducted to determine whether two indicators measured by ultrasound are good predictors of fluid responsiveness of parturients with spontaneous respiration in elective cesarean delivery.

DESIGN

A prospective cohort study.

SETTING

A single-center tertiary specialty hospital in China.

PATIENTS: A total of 86 patients scheduled for elective cesarean section were included and 6 were excluded for various reasons.

INTERVENTIONS: Based on the results of the fluid challenge, the included parturients were divided into two groups, with those who responded to fluid challenge defined as the positive group and those who did not respond defined as the negative group.

MAIN OUTCOME MEASURES: The primary endpoint was to determine the predictive value of IJV-CI and SCV-CI for fluid responsiveness (≥15% increases in SVI after fluid challenge) in spontaneous respiration patients.

RESULTS

Forty-three (53.8%) parturients were fluid responders. IJV-CI and SCV-CI proved to be the independent predictors for fluid responsiveness by multivariate logistic regression. The area under the ROC curve for IJV-CI and SCV-CI were 0.881 (95% CI, 0.808-0.953, p < 0.0005) and 0.757 (95% CI, 0.648-0.865, p < 0.0008), respectively. Their optimal cut-off values for IJV-CI and SCV-CI were 20.7% (sensitivity of 60%; specificity of 79%) and 32.0% (sensitivity of 34%; specificity of 96%), respectively. The grey zone for IJV-CI and SCV-CI for fluid responsiveness were 20.4-32.4% and 30.4-44.6% and included 25% and 23% of the patients, respectively.

CONCLUSION

Ultrasonic-derived IJV-CI is better than SCV-CI in predicting fluid responsiveness in spontaneously breathing parturients. Both IJV-CI and SCV-CI are the accurate and readily accessible indices of fluid responsiveness in parturients undergoing elective cesarean delivery.

TRIAL REGISTRATION: chictr.org.cn (ChiCTR1900028450).