Respiratory variation in inferior vena cava diameter: surrogate of central venous pressure or parameter of fluid responsiveness? Let the physiology reply

In the previous issue of Critical Care, Muller and colleagues investigated whether respiratory variation in inferior vena cava diameter (ΔIVC) could be a useful predictor of fluid responsiveness in spontaneously breathing patients. The study concludes that accuracy was not very good and therefore that this parameter should be used with caution in these patients. There is still confusion about the meaning of IVC respiratory variations, whether the patient is spontaneously breathing or mechanically ventilated. In this brief commentary, we try to summarize as clearly as possible the significance of IVC variation in different clinical settings.