Inferior vena cava distensibility from subcostal and trans-hepatic imaging using both M-mode or artificial intelligence: a prospective study on mechanically ventilated patients.
Critical care
Inferior vena cava
Subcostal
Transhepatic
Ultrasound
Journal
Intensive care medicine experimental
ISSN: 2197-425X
Titre abrégé: Intensive Care Med Exp
Pays: Germany
ID NLM: 101645149
Informations de publication
Date de publication:
10 Jul 2023
10 Jul 2023
Historique:
received:
17
03
2023
accepted:
03
06
2023
medline:
10
7
2023
pubmed:
10
7
2023
entrez:
9
7
2023
Statut:
epublish
Résumé
Variation of inferior vena cava (IVC) is used to predict fluid-responsiveness, but the IVC visualization with standard sagittal approach (SC, subcostal) cannot be always achieved. In such cases, coronal trans-hepatic (TH) window may offer an alternative, but the interchangeability of IVC measurements in SC and TH is not fully established. Furthermore, artificial intelligence (AI) with automated border detection may be of clinical value but it needs validation. Prospective observational validation study in mechanically ventilated patients with pressure-controlled mode. Primary outcome was the IVC distensibility (IVC-DI) in SC and TH imaging, with measurements taken both in M-Mode or with AI software. We calculated mean bias, limits of agreement (LoA), and intra-class correlation (ICC) coefficient. Thirty-three patients were included. Feasibility rate was 87.9% and 81.8% for SC and TH visualization, respectively. Comparing imaging from the same anatomical site acquired with different modalities (M-Mode vs AI), we found the following IVC-DI differences: (1) SC: mean bias - 3.1%, LoA [- 20.1; 13.9], ICC = 0.65; (2) TH: mean bias - 2.0%, LoA [- 19.3; 15.4], ICC = 0.65. When comparing the results obtained from the same modality but from different sites (SC vs TH), IVC-DI differences were: (3) M-Mode: mean bias 1.1%, LoA [- 6.9; 9.1], ICC = 0.54; (4) AI: mean bias 2.0%, LoA [- 25.7; 29.7], ICC = 0.32. In patients mechanically ventilated, AI software shows good accuracy (modest overestimation) and moderate correlation as compared to M-mode assessment of IVC-DI, both for SC and TH windows. However, precision seems suboptimal with wide LoA. The comparison of M-Mode or AI between different sites yields similar results but with weaker correlation. Trial registration Reference protocol: 53/2022/PO, approved on 21/03/2022.
Sections du résumé
BACKGROUND
BACKGROUND
Variation of inferior vena cava (IVC) is used to predict fluid-responsiveness, but the IVC visualization with standard sagittal approach (SC, subcostal) cannot be always achieved. In such cases, coronal trans-hepatic (TH) window may offer an alternative, but the interchangeability of IVC measurements in SC and TH is not fully established. Furthermore, artificial intelligence (AI) with automated border detection may be of clinical value but it needs validation.
METHODS
METHODS
Prospective observational validation study in mechanically ventilated patients with pressure-controlled mode. Primary outcome was the IVC distensibility (IVC-DI) in SC and TH imaging, with measurements taken both in M-Mode or with AI software. We calculated mean bias, limits of agreement (LoA), and intra-class correlation (ICC) coefficient.
RESULTS
RESULTS
Thirty-three patients were included. Feasibility rate was 87.9% and 81.8% for SC and TH visualization, respectively. Comparing imaging from the same anatomical site acquired with different modalities (M-Mode vs AI), we found the following IVC-DI differences: (1) SC: mean bias - 3.1%, LoA [- 20.1; 13.9], ICC = 0.65; (2) TH: mean bias - 2.0%, LoA [- 19.3; 15.4], ICC = 0.65. When comparing the results obtained from the same modality but from different sites (SC vs TH), IVC-DI differences were: (3) M-Mode: mean bias 1.1%, LoA [- 6.9; 9.1], ICC = 0.54; (4) AI: mean bias 2.0%, LoA [- 25.7; 29.7], ICC = 0.32.
CONCLUSIONS
CONCLUSIONS
In patients mechanically ventilated, AI software shows good accuracy (modest overestimation) and moderate correlation as compared to M-mode assessment of IVC-DI, both for SC and TH windows. However, precision seems suboptimal with wide LoA. The comparison of M-Mode or AI between different sites yields similar results but with weaker correlation. Trial registration Reference protocol: 53/2022/PO, approved on 21/03/2022.
Identifiants
pubmed: 37423948
doi: 10.1186/s40635-023-00529-z
pii: 10.1186/s40635-023-00529-z
pmc: PMC10329966
doi:
Types de publication
Journal Article
Langues
eng
Pagination
40Informations de copyright
© 2023. The Author(s).
Références
Crit Care. 2012 Oct 08;16(5):R188
pubmed: 23043910
Ann Intensive Care. 2016 Dec;6(1):111
pubmed: 27858374
BMC Anesthesiol. 2021 Nov 5;21(1):269
pubmed: 34740312
Br J Anaesth. 2021 Apr;126(4):826-834
pubmed: 33461735
J Ultrasound Med. 2022 Apr;41(4):855-863
pubmed: 34133034
Biomedicines. 2022 May 06;10(5):
pubmed: 35625819
Rev Bras Ter Intensiva. 2019 Jun 27;31(2):240-247
pubmed: 31271627
Crit Care Med. 2019 Feb;47(2):e89-e95
pubmed: 30394918
Intensive Care Med. 2021 Jan;47(1):1-13
pubmed: 33275163
Crit Care. 2015 Nov 13;19:400
pubmed: 26563768
Ann Intensive Care. 2021 Dec 15;11(1):175
pubmed: 34910264
J Intensive Care Med. 2021 Oct;36(10):1223-1227
pubmed: 34169764
Intensive Care Med. 2019 Jun;45(6):770-788
pubmed: 30911808
Indian J Crit Care Med. 2015 Dec;19(12):719-22
pubmed: 26816446
Singapore Med J. 2003 Dec;44(12):614-9
pubmed: 14770254
Minerva Anestesiol. 2017 Jun;83(6):537-539
pubmed: 28211652
Ann Transl Med. 2018 Sep;6(18):352
pubmed: 30370279
Intensive Care Med. 2015 Mar;41(3):544-6
pubmed: 25656354
J Ultrasound Med. 2021 Aug;40(8):1495-1504
pubmed: 33038035
J Am Soc Echocardiogr. 2022 Dec;35(12):1247-1255
pubmed: 35753590
Shock. 2019 Jul;52(1):37-42
pubmed: 31188800
Stat Methods Med Res. 2013 Dec;22(6):630-42
pubmed: 21705434
J Healthc Eng. 2021 Dec 6;2021:1336762
pubmed: 34912531
Intensive Care Med. 2004 Sep;30(9):1740-6
pubmed: 15034650
Crit Care. 2019 May 16;23(1):179
pubmed: 31097012
Echocardiography. 2022 Feb;39(2):223-232
pubmed: 35034377
J Crit Care. 2020 Feb;55:16-21
pubmed: 31670149
J Cardiothorac Vasc Anesth. 2017 Jun;31(3):973-979
pubmed: 28366714
Echocardiography. 2020 Aug;37(8):1171-1176
pubmed: 32757463
Intensive Care Med. 2018 Feb;44(2):197-203
pubmed: 29356854
Comput Biol Med. 2022 Jul;146:105637
pubmed: 35617727
Ann Intensive Care. 2019 Oct 7;9(1):113
pubmed: 31591663
Intensive Care Med Exp. 2023 Apr 3;11(1):15
pubmed: 37009935
Crit Care Med. 2017 Mar;45(3):e290-e297
pubmed: 27749318
J Cardiothorac Vasc Anesth. 2021 Sep;35(9):2834
pubmed: 33731297
Med Intensiva (Engl Ed). 2021 Dec;45(9):552-562
pubmed: 34839886
West J Emerg Med. 2017 Apr;18(3):496-501
pubmed: 28435502
Heart. 2022 Sep 26;108(20):1592-1599
pubmed: 35144983
Appl Bionics Biomech. 2022 Jun 1;2022:6410103
pubmed: 35694277
Ann Intensive Care. 2020 Apr 25;10(1):49
pubmed: 32335780
J Crit Care. 2022 Oct;71:154108
pubmed: 35797826