title: Inferior vena cava diameter variation compared with pulse pressure variation as predictors of fluid responsiveness in patients with sepsis.
abstract: Currently, physicians employ pulse pressure variation (PPV) as a gold standard for predicting fluid responsiveness. However, employing ultrasonography in intensive care units is increasing, including using the ultrasonography for assessment of fluid responsiveness. Data comparing the performance of both methods are still lacking. This is the reason for the present study.
  
  
  
  We conducted a prospective observational study in patients with sepsis requiring fluid challenge. The PPV, inferior vena cava diameter variation (IVDV), stroke volume variation (SVV), and the other hemodynamic variables were recorded before and after fluid challenges. Fluid responders were identified when cardiac output increased more than 15% after fluid loading.
  
  
  
  A total of 29 patients with sepsis were enrolled in this study. Sixteen (55.2%) were fluid responders. Threshold values to predict fluid responsiveness were 13.8% of PPV (sensitivity 100% and specificity 84.6%), 10.2% of IVDV (sensitivity 75% and specificity 76.9%) and 10.7% of SVV (sensitivity 81.3% and specificity 76.9%). The area under the curves of receiver operating characteristic showed that PPV (0.909, 95% confidence interval [CI], 0.784-1.00) and SVV (0.812, 95% CI, 0.644-0.981) had greater performance than IVDV (0.688, 95% CI, 0.480-0.895) regarding fluid responsiveness assessment.
  
  
  
  The present study demonstrated better performance of the PPV than the IVDV. A threshold value more than 10% may be used for identifying fluid responders.
authors: Division of Pulmonary and Critical Care Medicine, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, 270, Rama 6 Road, Thung Phaya Thai, Ratchathewi, Bangkok 10400, Thailand. Electronic address: pongdhep.the@mahidol.ac.th.
authors: Pongdhep
authors: P
authors: Theerawit
authors: Division of Pulmonary and Critical Care Medicine, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, 270, Rama 6 Road, Thung Phaya Thai, Ratchathewi, Bangkok 10400, Thailand. Electronic address: thot_kwan@hotmail.com.
authors: Thotsaporn
authors: T
authors: Morasert
authors: Division of Pulmonary and Critical Care Medicine, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, 270, Rama 6 Road, Thung Phaya Thai, Ratchathewi, Bangkok 10400, Thailand. Electronic address: sutherasan_yuda@yahoo.com.
authors: Yuda
authors: Y
authors: Sutherasan
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001794:Blood Pressure; D002302:Cardiac Output; D004452:Echocardiography; D005260:Female; D005440:Fluid Therapy; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008875:Middle Aged; D009929:Organ Size; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D012372:ROC Curve; D018805:Sepsis / Q000503:physiopathology / Q000628:therapy; D012772:Shock, Septic / Q000503:physiopathology / Q000628:therapy*; D013318:Stroke Volume; D014682:Vena Cava, Inferior / Q000000981:diagnostic imaging* / Q000473:pathology
keywords: Inferior vena cava diameter fluid; Inferior vena cava diameter ultrasound; Pulse pressure variation; Sepsis; Septic shock