title: 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.
  
  
  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.
authors.affiliation: Medical and Surgical Intensive Care Unit, Hospital St. Germain-en-Laye, 20 rue Armagis, 78100 St Germain-en-Laye, France.
authors.forename: Christophe
authors.initials: C
authors.lastname: Barbier
authors.forename: Yann
authors.initials: Y
authors.lastname: Loubières
authors.forename: Christophe
authors.initials: C
authors.lastname: Schmit
authors.forename: Jan
authors.initials: J
authors.lastname: Hayon
authors.forename: Jean-Louis
authors.initials: JL
authors.lastname: Ricôme
authors.forename: François
authors.initials: F
authors.lastname: Jardin
authors.forename: Antoine
authors.initials: A
authors.lastname: Vieillard-Baron
mesh_terms: 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