Ultrasound assessment of the inferior vena cava for fluid responsiveness: easy, fun, but unlikely to be helpful
This is where I stand on the matter today, November 3rd, 2020. I am open to changing my mind with new data. Guiding fluid responsiveness, as I’ve covered here, is a huge pain in the butt. But giving patients either too little fluids or too much fluids increases mortality. That little feeling inside of “just doing something” isn’t the best thing.
When I was going to through fellowship, I was trained to perform this assessment of placing the US probe on the patients subxiphoid area and digging around until the IVC was found. I got pretty good at it, but I have to admit that I also haven’t used it in 2 years. I never found it to be as useful or reliable as I initially thought it would be. It’s a tool but it has many caveats. I remember reading this article and got some confirmation bias to how I already felt about the scan.
Fortunately, this article is free and you can download it on my website, eddyjoemd.com. The article illustrates the many caveats which any clinician developing the skill to perform this scan NEEDS to know. He discusses the technical limitations, confounding factors, and reviews the evidence in both patients who are spontaneously breathing and in those who are on the vent.
I’ll repeat again, if you are a medical student, emergency medicine resident, internal medicine resident, or any clinician learning and managing patients based on this scan, you need to know the limitations of it. At least until we find the holy grail of Critical Care where we find a way to know the correct amount of fluids to give our patients. Not a drop more or a drop less.
Millington, S.J. Can J Anesth/J Can Anesth (2019) 66: 633. https://doi.org/10.1007/s12630-019-01357-0