The respiratory variation in inferior vena cava diameter as a guide to fluid therapy.
OBJECTIVE
To investigate whether the respiratory variation in inferior vena cava diameter (DeltaD(IVC)) could be related to fluid responsiveness in mechanically ventilated patients.


METHODS
Prospective clinical study.


METHODS
Medical ICU of a non-university hospital.


METHODS
Mechanically ventilated patients with septic shock (n=39).


METHODS
Volume loading with 8 mL/kg of 6% hydroxyethylstarch over 20 min.


RESULTS
Cardiac output and DeltaD(IVC) were assessed by echography before and immediately after the standardized volume load. Volume loading induced an increase in cardiac output from 5.7+/-2.0 to 6.4+/-1.9 L/min (P<0.001) and a decrease in DeltaD(IVC) from 13.8+/-13.6 vs 5.2+/-5.8% (P<0.001). Sixteen patients responded to volume loading by an increase in cardiac output > or =15% (responders). Before volume loading, the DeltaD(IVC) was greater in responders than in non-responders (25+/-15 vs 6+/-4%, P<0.001), closely correlated with the increase in cardiac output (r=0.82, P<0.001), and a 12% DeltaD(IVC) cut-off value allowed identification of responders with positive and negative predictive values of 93% and 92%, respectively.


CONCLUSIONS
Analysis of DeltaD(IVC) is a simple and non-invasive method to detect fluid responsiveness in mechanically ventilated patients with septic shock.
Feissel
Marc
M
Réanimation médicale et maladies infectieuses, Centre hospitalier de Belfort, Belfort, France.
Michard
Frédéric
F
Faller
Jean-Pierre
JP
Teboul
Jean-Louis
JL
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002302:Cardiac Output; D004452:Echocardiography; D005260:Female; D005440:Fluid Therapy; D006761:Hospitals; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012121:Respiration, Artificial; D012772:Shock, Septic / Q000503:physiopathology*; D016896:Treatment Outcome; D014682:Vena Cava, Inferior / Q000473:pathology*