Role of the sonographic assessment of fluid estimate score on evaluating intravascular volume status in critically ill patients
DOI:
https://doi.org/10.18203/2320-6012.ijrms20242599Keywords:
SAFE score, Volume status, Ultracritically ill, Intravascular volume, ICU, Non-invasive assessmentAbstract
Background: Study aim to establish standardized scoring system using bedside ultrasonography to evaluate intravascular volume status in critically ill patients and to correlate this with traditional physician assessment methods.
Methods: A prospective pragmatic observational study was conducted at Narayana health city from August 2021 to February 2022, involving 100 adult medical ICU patients requiring volume status assessment. Patients with local infection, trauma, or increased intra-abdominal pressure were excluded. Volume status was categorized as hypovolemic, euvolemic, or hypervolemic using both the intensivist’s methods and the sonographic assessment of fluid estimate (SAFE) score. The agreement between these methods was analyzed.
Results: The SAFE score showed a high agreement with the physician’s assessment methods, with a Kappa value of 0.91. The SAFE score demonstrated sensitivity of 100 % and specificity of 100% for identifying hypervolemic (score>1) and (score≤-1) for patients with hypovolemia, both with 100% positive and negative predictive values. For euvolemic patients, the SAFE score had 57.47% specificity, a 26% PPV, and a 100% NPV. Subgroup analyses, including mechanically ventilated patients, those with ARDS, vasopressor requirements, and septic shock, confirmed statistically significant agreement between the two methods.
Conclusions: The SAFE score is a reliable, non-invasive, cost-effective, and time-efficient method to assess volume status in critically ill ICU patients. It offers a standardized alternative to traditional assessment techniques, with specific thresholds indicating hypovolemia (>-2), hypervolemia (> 2), and euvolemia (-1 to 1).
References
Kalantari K, Chang JN, Ronco C, Rosner MH. Assessment of intravascular volume status and volume responsiveness in critically ill patients. Kidney Int Elsevier. 2015.
Vincent J-L. Intravascular Volume Assessment in the Critically Ill Patient. Clin J Am Society Nephrol. 2019;15(4):557-9.
Pourmand A, Pyle M, Yamane D, Sumon K, Frasure SE. The utility of point- of-care ultrasound in the assessment of volume status in acute and critically ill patients. World J Emergency Med. 2019;10(4):232.
Killu K, Coba V, Blyden D, Munie S, Dereczyk D, Kandagatla P, et al. Sonographic Assessment of Intravascular Fluid Estimate (SAFE) Score by Using Bedside Ultrasound in the Intensive Care Unit. Crit Care Res Pract. 2020;2020:1-9.
5.Frankel HL, Kirkpatrick AW, Elbarbary M, Blaivas M, Desai H, Evans D, et al. Guidelines for the Appropriate Use of Bedside General and Cardiac Ultrasonography in the Evaluation of Critically Ill Patients-Part I. Critical Care Med. 2015;43(11):2479-502.
Levitov A, Frankel HL, Blaivas M, Kirkpatrick AW, Su E, Evans D, et al. Guidelines for the Appropriate Use of Bedside General and Cardiac Ultrasonography in the Evaluation of Critically Ill Patients-Part II. Critical Care Med. 2016;44(6):1206-2.
Mackenzie D, Noble V. Assessing volume status and fluid responsiveness in the emergency department. Clin Experimental Emergency Med. 2014;1(2):67-77.
The American College of Emergency Physicians, Ultrasound Guidelines: Emergency, Point of Care, and Clinical Ultrasound Guidelines in Medicine, American College of Emergencyphysicians, Irving, TX, USA, 2016. Available at: https://www.acep.org/globalassets/newpdfs/policy-statements/ultrasound-guidelines-emergency-point-of-care-and-clinical- ultrasound-guidelinesin-medicine.pdf. Accessed on 12 April, 2024.
Spencer K, Kimura B, Korcarz C, Pellikka P, Rahko P, Siegel R. Focused Cardiac Ultrasound: Recommendations from the American Society of Echocardiography. J Am Society Echocardiography. 2013;26(6):567-81.
Via G, Hussain A, Wells M, Reardon R, ElBarbary M, Noble VE, et al. International Evidence-Based Recommendations for Focused Cardiac Ultrasound. J Am Society Echocardiography. 2014;27(7):15.
Lichtenstein D, Mezière G. A lung ultrasound sign allowing bedside distinction between pulmonary edema and COPD: the comet-tail artifact. Intensive Care Med. 1998;24(12):1331-4.
Lichtenstein DA, Mezière GA, Lagoueyte J-F, Biderman P, Goldstein I, Gepner A. A-Lines and B-Lines. Chest. 2009;136(4):1014-20.
Lichtenstein DA. Lung ultrasound in the critically ill. Ann Intensive Care. 2014;4(1):1
Volpicelli G, Elbarbary M, Blaivas M, Lichtenstein DA, Mathis G, Kirkpatrick AW, et al. International evidence-based recommendations for point-of-care lung ultrasound. Intensive Care Med. 2012;38(4):577-91.
Zhang Z, Xu X, Ye S, Xu L. Ultrasonographic Measurement of the Respiratory Variation in the Inferior Vena Cava Diameter Is Predictive of Fluid Responsiveness in Critically Ill Patients: Systematic Review and Meta- analysis. Ultrasound Med Biol. 2014;40(5):845-53.
Feissel M, Michard F, Faller J-P, Teboul J-L. The respiratory variation in inferior vena cava diameter as a guide to fluid therapy. Intensive Care Med. 2004;30(9):10.
Barbier C, Loubières Y, Schmit C, Hayon J, Ricôme J-L, Jardin F, et al. Respiratory changes in inferior vena cava diameter are helpful in predicting fluid responsiveness in ventilated septic patients. Intensive Care Med. 2004;30(9):1740-6.
Sefidbakht S, Assadsangabi R, Abbasi HR, Nabavizadeh A. Sonographic measurement of the inferior vena cava as a predictor of shock in trauma patients. Emergency Radiol. 2007;14(3):181-5.
Broilo F, Meregalli A, Friedman G. Right internal jugular vein distensibility appears to be a surrogate marker for inferior vena cava vein distensibility for evaluating fluid responsiveness. Revista Brasileira Terapia Intensiva. 2015;27(3):1.
Keller AS, Melamed R, Malinchoc M, John R, Tierney DM, Gajic O. Diagnostic accuracy of a simple ultrasound measurement to estimate central venous pressure in spontaneously breathing, critically ill patients. J Hospital Med. 2009;4(6):350-5.
Killu K, Coba V, Huang Y, Andrezejewski T, Dulchavsky S. Internal jugular vein collapsibility index associated with hypovolemia in the intensive care unit patients. Crit Ultrasound J. 2010;2(1):13-7.
Ilyas A, Ishtiaq W, Assad S, Ghazanfar H, Mansoor S, Haris M, et al. Correlation of Inferior Vena Cava Diameter and Collapsibility Index With Central Venous Pressure in the Assessment of Intravascular Volume in Critically Ill Patients. Cureus. 2017;9(2):e1025.
Kent A, Patil P, Davila V, Bailey JK, Jones C, Evans DC, et al. Sonographic evaluation of intravascular volume status: can internal jugular or femoral vein collapsibility be used in the absence of Inferior Vena Cava visualization? Ann Thoracic Med. 2015;10(1):44-9.
Seif D, Perera P, Mailhot T, Riley D, Mandavia D. Bedside Ultrasound in Resuscitation and the Rapid Ultrasound in Shock Protocol. Crit Care Res Pract. 2012;2012:1-14.
Scalea TM, Rodriguez A, Chiu WC, Brenneman FD, Fallon WF, Kato K, et al. Focused Assessment with Sonography for Trauma (FAST). J Trauma Injury Infect Crit Care. 1999;46(3):466-72.
Dakhale GN, Hiware SK, Shinde AT, Mahatme MS. Basic biostatistics for post-graduate students. Indian J Pharmacol. 2012;44(4):435-42.
Sunder Rao PSS, Richard J. An Introduction to Biostatistics, A manual for students in health sciences, New Delhi: Prentice Hall of India. 4th edition. 2006;86-160.
Elenbaas, RM, Elenbaas, JK, Cuddy, PG. Evaluating the medical literature, part II: Statistical analysis. Ann Emerg Med. 1983;12:610-20.
Yildizdas D, Aslan N. Ultrasonographic inferior vena cava collapsibility and distensibility indices for detecting the volume status of critically ill pediatric patients. J Ultrason. 2020;20(82):e205-9.
Marik PE. Lactate guided resuscitation-nothing is more dangerous than conscientious foolishness. J Thorac Dis. 2019;11(15):S1969-72.
Kattan E, Hernández G, Ospina-Tascón G, Valenzuela ED, Bakker J, Castro R, et al. A lactate-targeted resuscitation strategy may be associated with higher mortality in patients with septic shock and normal capillary refill time: a post hoc analysis of the ANDROMEDA-SHOCK study. Ann Intensive Care. 2020;10(1):114.
Mishra RK, Pande A, Ramachandran R, Trikha A, Singh PM, Rewari V. Effect of Change in Body Weight on Clinical Outcomes in Critically Ill Patients. Indian J Crit Care Med. 2021;25(9):1042-8.
Marik PE, Cavallazzi R, Vasu T, Hirani A. Dynamic changes in arterial waveform derived variables and fluid responsiveness in mechanically ventilated patients: a systematic review of the literature. Crit Care Med. 2009;37(9):2642-7.
Marik PE, Lemson J. Fluid responsiveness: an evolution of our understanding. Br J Anaesth. 2014;112(4):617-20.
Marik PE, Monnet X, Teboul JL. Hemodynamic parameters to guide fluid therapy. Ann Intensive Care. 2011;1(1):1.
