Respiratory changes in inferior vena cava diameter are helpful in predicting fluid responsiveness in ventilated septic patients.
OBJECTIVE
To evaluate the extent to which respiratory changes in inferior vena cava (IVC) diameter can be used to predict fluid responsiveness.


METHODS
Prospective clinical study.


METHODS
Hospital intensive care unit.


METHODS
Twenty-three patients with acute circulatory failure related to sepsis and mechanically ventilated because of an acute lung injury.


METHODS
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.


CONCLUSIONS
Our study suggests that respiratory change in IVC diameter is an accurate predictor of fluid responsiveness in septic patients.
Barbier
Christophe
C
Medical and Surgical Intensive Care Unit, Hospital St. Germain-en-Laye, 20 rue Armagis, 78100 St Germain-en-Laye, France.
Loubières
Yann
Y
Schmit
Christophe
C
Hayon
Jan
J
Ricôme
Jean-Louis
JL
Jardin
François
F
Vieillard-Baron
Antoine
A
D000328:Adult; D000368:Aged; D001794:Blood Pressure; D002496:Central Venous Pressure; D015150:Echocardiography, Doppler; D006334:Heart Function Tests; D006339:Heart Rate; D006801:Humans; D007362:Intensive Care Units; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D012121:Respiration, Artificial; D012131:Respiratory Insufficiency / Q000209:etiology / Q000503:physiopathology* / Q000628:therapy; D018805:Sepsis / Q000150:complications / Q000503:physiopathology* / Q000628:therapy; D014682:Vena Cava, Inferior / Q000473:pathology* / Q000503:physiopathology