title: The intrathoracic blood volume index as an indicator of fluid responsiveness in critically ill patients with acute circulatory failure: a comparison with central venous pressure.
abstract: BACKGROUND
  The intrathoracic blood volume index (ITBVI) and central venous pressure (CVP) are routinely used to predict fluid responsiveness in critically ill patients with acute circulatory failure (systolic blood pressure < 90 mm Hg or vasopressor requirement). However, they have never been compared.
  
  
  METHODS
  In this prospective interventional study, we included 35 (21 men) mechanically ventilated and sedated patients with acute cardiovascular failure requiring cardiac output measurement (transpulmonary thermodilution technique). Fluid responsiveness was defined as an increase in stroke index (cardiac output/heart rate/body surface area) > or =15%. Receiver operating characteristic curves were generated for ITBVI and CVP.
  
  
  RESULTS
  Fluid challenge induced a stroke index increase > or =15% in 18 (51%) patients (responders). At baseline, no studied hemodynamic variables were different between responders and nonresponders. The areas under the receiver operating characteristic curves were 0.64 [95% CI: 0.46-0.80] for ITBVI and 0.68 [95% CI: 0.50-0.83] for CVP, without any statistical difference (P = 0.73). The best cut-off values for CVP and ITBVI were 9 mm Hg (sensitivity = 61%; specificity = 82%) and 928 mL . m(-2) (sensitivity = 78%; specificity = 53%).
  
  
  CONCLUSIONS
  ITBVI is similar to CVP in its ability to predict fluid responsiveness in critically ill patients with acute circulatory failure.
authors.affiliation: Division Anesthésie Réanimation Douleur Urgences, Groupe Hospitalo-Universitaire Caremeau, CHU Nîmes, Place du Professeur Robert Debré, 30029 Nîmes Cedex 9, France.
authors.forename: Laurent
authors.initials: L
authors.lastname: Muller
authors.forename: Guillaume
authors.initials: G
authors.lastname: Louart
authors.forename: Christian
authors.initials: C
authors.lastname: Bengler
authors.forename: Pascale
authors.initials: P
authors.lastname: Fabbro-Peray
authors.forename: Julie
authors.initials: J
authors.lastname: Carr
authors.forename: Jacques
authors.initials: J
authors.lastname: Ripart
authors.forename: Jean-Emmanuel
authors.initials: JE
authors.lastname: de La Coussaye
authors.forename: Jean-Yves
authors.initials: JY
authors.lastname: Lefrant
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001810:Blood Volume; D002302:Cardiac Output; D002496:Central Venous Pressure; D016638:Critical Illness / Q000628:therapy*; D005260:Female; D006439:Hemodynamics; D006801:Humans; D006895:Hydroxyethyl Starch Derivatives / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000503:physiopathology; D010952:Plasma Substitutes / Q000008:administration & dosage*; D012372:ROC Curve; D012121:Respiration, Artificial; D012769:Shock / Q000503:physiopathology / Q000628:therapy*; D013318:Stroke Volume; D013909:Thorax
chemical_list: D006895:Hydroxyethyl Starch Derivatives; D010952:Plasma Substitutes