title: The respiratory variation in inferior vena cava diameter as a guide to fluid therapy.
abstract: 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.
authors.affiliation: Réanimation médicale et maladies infectieuses, Centre hospitalier de Belfort, Belfort, France.
authors.forename: Marc
authors.initials: M
authors.lastname: Feissel
authors.forename: Frédéric
authors.initials: F
authors.lastname: Michard
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: Faller
authors.forename: Jean-Louis
authors.initials: JL
authors.lastname: Teboul
mesh_terms: 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*