medigraphic.com
ISSN 2448-8909 (Print)

2019, Number 5

<< Back Next >>

Med Crit 2019; 33 (5)

Behavior of collapsibility of vena cava inferior in controlled hemorrhage

Atlas RJM, Montelongo FJ, Carmona DA

Language: Spanish
References: 16
Page: 233-237
PDF size: 141.67 Kb.


ABSTRACT

Introduction: Ultrasonography is an indispensable tool in the diagnosis and monitoring of critically ill patients during the last three decades. Currently the diagnosis of hypovolemic shock is made through the monitoring of vital signs, the identification and quantification of blood loss and markers of tissue hypoperfusion. However, it has been amply demonstrated that hypotension and tachycardia are not specific or sensitive to perform such a diagnosis at the same time that they are altered in advanced stages of the shock state, so they are ineffective in the early identification and decision making. of tissue hypoperfusion are expensive and the necessary supplies are not always available.
Methodology: The collapse of the inferior vena cava was measured in healthy patients before and after the 450 cm3 donation in the state blood bank of Ecatepec during the period from March to August 2017. It was performed in patients between 16 and 65 years of age, who were healthy, who agreed to participate in the study after signing an informed consent letter and in which it was technically feasible to measure the variables with ultrasound, taking as a universe the measurement performed in 87 patients of which 75% were male and 25% were female, inferior vena cava collapsibility was measured before and after performing the 450 cm3 exsanguination, the circulating blood volume and permissible bleeding were calculated, it was calculated the percentage of permissible bleeding equivalent to 450 cm3 in each patient and the blood loss was homologous with the percentage of blood loss proposed by the college of surgeons for the classification of hemorrhagic shock.
Conclusion: With the universe of patients reviewed, it is proposed to add the measurement of inferior vena cava collapsibility as a complementary, accessible and inexpensive evaluation in the complementation of the diagnosis and monitoring of hypovolemic shock in ICU and emergency patients.


REFERENCES

  1. Poelaert J. Use of ultrasound in the ICU. Best Pract Res Clin Anaesthesiol. 2009;23(3):249-261.

  2. Rodríguez TB, Franco GJ. Historia de la medicina crítica. An Med Asoc Med Hosp ABC. 2015;60(2):156-159.

  3. Muller L, Bobbia X, Toumi M, Louart G, Molinari N, Ragonnet B, et al. Respiratory variations of inferior vena cava diameter to predict fluid responsiveness in spontaneously breathing patients with acute circulatory failure: need for a cautious use. Crit Care. 2012;16(5):R188.

  4. De Backer D, Fagnoul D. Intensive care ultrasound: VI. Fluid responsiveness and shock assessment. Ann Am Thorac Soc. 2014;11(1):129-136.

  5. Finnerty NM, Panchal AR, Boulger C, Vira A, Bischof JJ, Amick C, et al. Inferior vena cava measurement with ultrasound: what is the best view and best mode? West J Emerg Med. 2017;18(3):496-501.

  6. Motta-Ramírez GA, Mundo-Gómez C, Ramírez-Arias JL. La vena cava y sus variantes anatómicas. Rev Mex Angiol. 2010;38(1):19-29.

  7. Carrillo-Esper R, Tapia-Velasco R, Galván-Talamantes Y, Garrido-Aguirre E. Evaluación de la precarga y respuesta a volumen mediante ultrasonografía de la vena cava. Rev Asoc Mex Med Crit y Ter Int. 2015;29(2):105-112.

  8. Arrioja AS, Herrera JE. Los secretos de la vena cava inferior. Revisión contemporánea. Av Cardiol. 2015;35(2):120-132.

  9. Miller A, Mandeville J. Predicting and measuring fluid responsiveness with echocardiography. Echo Res Pract. 2016;3(2):G1-G12.

  10. Guiotto G, Masarone M, Paladino F, Ruggiero E, Scott S, Verde S, et al. Inferior vena cava collapsibility to guide fluid removal in slow continuous ultrafiltration: a pilot study. Intensive Care Med. 2010;36(4):692-696.

  11. Muller L, Toumi M, Bousquet PJ, Riu-Poulenc B, Louart G, Candela D, et al. An increase in aortic blood flow after an infusion of 100 ml colloid over 1 minute can predict fluid responsiveness: the mini-fluid challenge study. Anesthesiology. 2011;115(3):541-547.

  12. Rossaint R, Bouillon B, Cerny V, Coats TJ, Duranteau J, Fernández-Mondéjar E, et al. The European guideline on management of major bleeding and coagulopathy following trauma: fourth edition. Crit Care. 2016;20:100.

  13. Olaussen A, Blackburn T, Mitra B, Fitzgerald M. Review article: shock index for prediction of critical bleeding post-trauma: a systematic review. Emerg Med Australas. 2014;26(3):223-228.

  14. Manikis P, Jankowski S, Zhang H, Kahn RJ, Vincent JL. Correlation of serial blood lactate levels to organ failure and mortality after trauma. Am J Emerg Med. 1995;13(6):619-622.

  15. Caputo N, Fraser R, Paliga A, Kanter M, Hosford K, Madlinger R. Triage vital signs do not correlate with serum lactate or base deficit, and are less predictive of operative intervention in penetrating trauma patients: a prospective cohort study. Emerg Med J. 2013;30(7):546-550.

  16. Mutschler M, Nienaber U, Brockamp T, Wafaisade A, Fabian T, Paffrath T, et al. Renaissance of base deficit for the initial assessment of trauma patients: a base deficit-based classification for hypovolemic shock developed on data from 16,305 patients derived from the TraumaRegister DGU®. Crit Care. 2013;17(2):R42.




2020     |     www.medigraphic.com