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

Barbier, Christophe; Loubières, Yann; Schmit, Christophe; Hayon, Jan; Ricôme, Jean-Louis; Jardin, François; Vieillard-Baron, Antoine; Loubières, Yann; Ricôme, Jean-Louis; Jardin, François

<bold>Objective: </bold>To evaluate the extent to which respiratory changes in inferior vena cava (IVC) diameter can be used to predict fluid responsiveness.<bold>Design: </bold>Prospective clinical study.<bold>Setting: </bold>Hospital intensive care unit.<bold>Patients: </bold>Twenty-three patients with acute circulatory failure related to sepsis and mechanically ventilated because of an acute lung injury.<bold>Measurements: </bold>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%).<bold>Results: </bold>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.<bold>Conclusion: </bold>Our study suggests that respiratory change in IVC diameter is an accurate predictor of fluid responsiveness in septic patients.

RESPIRATORY insufficiency treatment; SEPTICEMIA treatment; ARTIFICIAL respiration; BLOOD pressure; CENTRAL venous pressure; CLINICAL trials; COMPARATIVE studies; DOPPLER echocardiography; HEART beat; HEART function tests; INTENSIVE care units; LONGITUDINAL method; RESEARCH methodology; MEDICAL cooperation; PROGNOSIS; RESEARCH; RESPIRATORY insufficiency; SEPSIS; VENA cava inferior; EVALUATION research; DISEASE complications

Intensive Care Medicine, 2004, Vol 30, Issue 9, p1740

0342-4642

Academic Journal

10.1007/s00134-004-2259-8