Respiratory changes in inferior vena cava diameter are helpful in predicting fluid responsiveness in ventilated septic patients.

Abstract:

OBJECTIVE:To evaluate the extent to which respiratory changes in inferior vena cava (IVC) diameter can be used to predict fluid responsiveness. DESIGN:Prospective clinical study. SETTING:Hospital intensive care unit. PATIENTS:Twenty-three patients with acute circulatory failure related to sepsis and mechanically ventilated because of an acute lung injury. MEASUREMENTS:Inferior vena cava diameter (D) at end-expiration (Dmin) and at end-inspiration (Dmax) was measured by echocardiography using a subcostal approach. The distensibility index of the IVC (dIVC) was calculated as the ratio of Dmax - Dmin / Dmin, and expressed as a percentage. The Doppler technique was applied in the pulmonary artery trunk to determine cardiac index (CI). Measurements were performed at baseline and after a 7 ml/kg volume expansion using a plasma expander. Patients were separated into responders (increase in CI > or =15%) and non-responders (increase in CI <15%). RESULTS:Using a threshold dIVC of 18%, responders and non-responders were discriminated with 90% sensitivity and 90% specificity. A strong relation (r = 0.9) was observed between dIVC at baseline and the CI increase following blood volume expansion. Baseline central venous pressure did not accurately predict fluid responsiveness. CONCLUSION:Our study suggests that respiratory change in IVC diameter is an accurate predictor of fluid responsiveness in septic patients.

journal_name

Intensive Care Med

journal_title

Intensive care medicine

authors

Barbier C,Loubières Y,Schmit C,Hayon J,Ricôme JL,Jardin F,Vieillard-Baron A

doi

10.1007/s00134-004-2259-8

keywords:

subject

Has Abstract

pub_date

2004-09-01 00:00:00

pages

1740-6

issue

9

eissn

0342-4642

issn

1432-1238

journal_volume

30

pub_type

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