The Diagnostic Value of Ultrasonic Measurement of Inferior Vena Cava Diameter Respiratory Variability on Volume Response Evaluation of Geriatric Hip Fracture

Abstract

Aim:

To evaluate the value of ultrasonic measurement of the respiratory variability of inferior vena cava (IVC) in the preoperative volume-response evaluation of elderly hip fracture patients.

Methods:

Volume-loading tests were carried out in elderly patients with hip fractures requiring surgical treatment from August 2017 to February 2018. The maximum diameter (IVCe) and minimum diameter (IVCi) of the IVC were measured by ultrasound, and the variation of IVC (IVC-CI) was calculated before surgery. SV was monitored by a FloTrac/Vigileo system, and positive volume responsiveness was defined as ΔSV increasing by more than 15%. The sensitivity and specificity of IVC-CI to volume responsiveness evaluation was analyzed by ROC, and the correlation between IVC-CI and ΔSV was analyzed by Spearman correlation analysis.

Results:

Ultrasound measurements and volume-loading tests were successfully performed in 39 of the 44 patients. Among them 21 cases were volume responsiveness positive (group R) and 18 cases were volume responsiveness negative (group N). Before the volume-loading test, IVCi in group R was significantly smaller than group N and IVC-CI was significantly larger than group N (P<0.05), while the difference between IVCe and group N was not statistically significant (P>0.05). After the volume-loading test, the differences between IVCe, IVCi, IVC-CI, and group N were not statistically significant (P>0.05). Area under curve (AUC) of IVC-CI to assess volume responsiveness in geriatric hip fracture patients was 0.80±0.08 (0.65-0.95, P=0.001), with a 20.69% cut off value, 77.78% sensitivity, and 76.19% specificity. Through the Pearson correlation analysis, IVC-CI and Δ SV were positively correlated with the coefficient r = 0.367 (P<0.05).

Discussion:

As a rapid and noninvasive monitoring method, ultrasonic measurement of the respiratory variability of inferior vena cava in assessing the volume responsiveness of geriatric hip fracture patients can provide guidance for perioperative fluid management.