Title:Subclavian Vein Collapsibility as a Predictor of Fluid Responsiveness in
Spontaneously Breathing Hypotensive Patients
Volume: 4
Author(s): Manjit Mahendran, Arvind Kumar*, Smriti Hari, Mohd Usman, Maroof Ahmad Khan, Piyush Ranjan, Manish Soneja, Naval K. Vikram, Ashutosh Biswas, Praveen Aggarwal and Naveet Wig
Affiliation:
- Department of Medicine, All India Institute of Medical Sciences (AIIMS), New Delhi, India
Keywords:
Subclavian vein, Fluid responsiveness, Circulatory shock, Spontaneous breathing, Vena Cava, Subclavian vein.
Abstract:
Background and Objective: Volume replacement remains the cornerstone of resuscitation in critically ill patients. This study explored the ability of the subclavian vein
collapsibility index to predict fluid responsiveness.
Methods: In this prospective observational study conducted in the Department of Medicine, All India Institute of Medical Sciences (AIIMS), New Delhi,
sonographic evaluation of inferior vena cava and the right subclavian vein was carried out at three time points for hypotensive patients admitted to
the emergency department. The study population was divided into two groups: responders and non-responders, based on a ≥ 15% increase in stroke
volume following fluid bolus.
Results: Among 45 recruited patients, 33 patients were responders. The area under the ROC curve for SCV CI at baseline to predict fluid responsiveness
was 0.745 (95% confidence interval: 0.549 – 0.941; p = 0.014). An SCV-CI of 46% predicted fluid responsiveness in a hypotensive patient in
terms of change in stroke volume by 15% following fluid bolus with a sensitivity of 87.88% (95% confidence interval: 71.80% to 96.60%) and
specificity of 66.67% (95% confidence interval: 34.89% to 90.08%). Spearman’s correlation coefficient between IVC CI and SCV CI was 0.59 (p
< 0.001, n = 135).
Conclusion: The results of the study demonstrated that right subclavian vein respiratory variation has the ability to predict fluid responsiveness in a
spontaneously breathing patient in circulatory shock and correlates with the inferior vena cava collapsibility index. The subclavian vein can be an
alternative to the inferior vena cava in predicting fluid responsiveness in spontaneously breathing patients.
