title: Predicting preload responsiveness using simultaneous recordings of inferior and superior vena cavae diameters.
abstract: BACKGROUND
  Echocardiographic indices based on respiratory variations of superior and inferior vena cavae diameters (ΔSVC and ΔIVC, respectively) have been proposed as predictors of fluid responsiveness in mechanically ventilated patients, but they have never been compared simultaneously in the same patient sample. The aim of this study was to compare the predictive value of these echocardiographic indices when concomitantly recorded in mechanically ventilated septic patients.
  
  
  METHODS
  Septic shock patients requiring hemodynamic monitoring were prospectively enrolled over a 1-year period in a mixed medical surgical ICU of a university teaching hospital (Toulouse, France). All patients were mechanically ventilated. Predictive indices were obtained by transesophageal and transthoracic echocardiography and were calculated as follows: (Dmax - Dmin)/Dmax for ΔSVC and (Dmax - Dmin)/Dmin for ΔIVC, where Dmax and Dmin are the maximal and minimal diameters of SVC and IVC. Measurements were performed at baseline and after a 7-ml/kg volume expansion using a plasma expander. Patients were separated into responders (increase in cardiac index ≥15%) and nonresponders (increase in cardiac index <15%).
  
  
  RESULTS
  Among 44 included patients, 26 (59%) patients were responders (R). ΔSVC was significantly more accurate than ΔIVC in predicting fluid responsiveness. The areas under the receiver operating characteristic curves for ΔSVC and ΔIVC regarding assessment of fluid responsiveness were significantly different (0.74 (95% confidence interval (CI): 0.59 to 0.88) and 0.43 (95% CI: 0.25 to 0.61), respectively (P = 0.012)). No significant correlation between ΔSVC and ΔIVC was found (r = 0.005, P = 0.98). The best threshold values for discriminating R from NR was 29% for ΔSVC, with 54% sensitivity and 89% specificity, and 21% for ΔIVC, with 38% sensitivity and 61% specificity.
  
  
  CONCLUSIONS
  ΔSVC was better than ΔIVC in predicting fluid responsiveness in our cohort. It is worth noting that the sensitivity and specificity values of ΔSVC and ΔIVC for predicting fluid responsiveness were lower than those reported in the literature, highlighting the limits of using these indices in a heterogeneous sample of medical and surgical septic patients.
authors.forename: Hélène
authors.initials: H
authors.lastname: Charbonneau
authors.forename: Béatrice
authors.initials: B
authors.lastname: Riu
authors.forename: Matthieu
authors.initials: M
authors.lastname: Faron
authors.forename: Arnaud
authors.initials: A
authors.lastname: Mari
authors.forename: Matt M
authors.initials: MM
authors.lastname: Kurrek
authors.forename: Jean
authors.initials: J
authors.lastname: Ruiz
authors.forename: Thomas
authors.initials: T
authors.lastname: Geeraerts
authors.forename: Olivier
authors.initials: O
authors.lastname: Fourcade
authors.forename: Michèle
authors.initials: M
authors.lastname: Genestal
authors.forename: Stein
authors.initials: S
authors.lastname: Silva
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002302:Cardiac Output; D004452:Echocardiography / Q000379:methods*; D005260:Female; D005440:Fluid Therapy / Q000379:methods; D006801:Humans; D020896:Hypovolemia / Q000503:physiopathology; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D010952:Plasma Substitutes / Q000627:therapeutic use; D011446:Prospective Studies; D012372:ROC Curve; D012121:Respiration, Artificial; D012680:Sensitivity and Specificity; D012772:Shock, Septic / Q000503:physiopathology* / Q000628:therapy; D018709:Statistics, Nonparametric; D016896:Treatment Outcome; D014682:Vena Cava, Inferior / Q000033:anatomy & histology / Q000000981:diagnostic imaging / Q000503:physiopathology*; D014683:Vena Cava, Superior / Q000033:anatomy & histology / Q000000981:diagnostic imaging / Q000503:physiopathology*
chemical_list: D010952:Plasma Substitutes