title: Comparison of Echocardiographic Indices Used to Predict Fluid Responsiveness in Ventilated Patients.
abstract: BACKGROUND
  Assessment of fluid responsiveness relies on dynamic echocardiographic parameters that have not yet been compared in large cohorts.
  
  
  OBJECTIVE
  To determine the diagnostic accuracy of dynamic parameters used to predict fluid responsiveness in ventilated patients with a circulatory failure of any cause.
  
  
  METHODS
  In this multicenter prospective study, respiratory variations of superior vena cava diameter (∆SVC) measured using transesophageal echocardiography, of inferior vena cava diameter (∆IVC) measured using transthoracic echocardiography, of the maximal Doppler velocity in left ventricular outflow tract (∆VmaxAo) measured using either approach, and pulse pressure variations (∆PP) were recorded with the patient in the semirecumbent position. In each patient, a passive leg raise was performed and an increase of aortic velocity time integral greater than or equal to 10% defined fluid responsiveness.
  
  
  RESULTS
  Among 540 patients (379 men; age, 65 ± 13 yr; Simplified Acute Physiological Score II, 59 ± 18; Sequential Organ Failure Assessment, 10 ± 3), 229 exhibited fluid responsiveness (42%). ∆PP, ∆VmaxAo, ∆SVC, and ∆IVC could be measured in 78.5%, 78.0%, 99.6%, and 78.1% of cases, respectively. ∆SVC greater than or equal to 21%, ∆VmaxAo greater than or equal to 10%, and ∆IVC greater than or equal to 8% had a sensitivity of 61% (95% confidence interval, 57-66%), 79% (75-83%), and 55% (50-59%), respectively, and a specificity of 84% (81-87%), 64% (59-69%), and 70% (66-75%), respectively. The area under the receiver operating characteristic curve of ∆SVC was significantly greater than that of ∆IVC (P = 0.02) and ∆PP (P = 0.01).
  
  
  CONCLUSIONS
  ∆VmaxAo had the best sensitivity and ∆SVC the best specificity in predicting fluid responsiveness. ∆SVC had a greater diagnostic accuracy than ∆IVC and ∆PP, but its measurement requires transesophageal echocardiography.
authors.affiliation: 1 Medical-Surgical Intensive Care Unit and.|2 INSERM CIC 1435, Limoges University Hospital, Limoges, France.|3 Faculty of Medicine, University of Limoges, Limoges, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Vignon
authors.affiliation: 4 Intensive Care Unit, Assistance Publique-Hôpitaux de Paris, University Hospital Ambroise Paré, Boulogne-Billancourt, France.
authors.forename: Xavier
authors.initials: X
authors.lastname: Repessé
authors.affiliation: 1 Medical-Surgical Intensive Care Unit and.|2 INSERM CIC 1435, Limoges University Hospital, Limoges, France.
authors.forename: Emmanuelle
authors.initials: E
authors.lastname: Bégot
authors.affiliation: 5 INSERM CIC 1415, Tours University Hospital, Tours, France.
authors.forename: Julie
authors.initials: J
authors.lastname: Léger
authors.affiliation: 6 Medical Intensive Care Unit, Brest University Hospital, Brest, France.
authors.forename: Christophe
authors.initials: C
authors.lastname: Jacob
authors.affiliation: 7 Medical-Surgical Intensive Care Unit, Foch Hospital, Paris, France.
authors.forename: Koceila
authors.initials: K
authors.lastname: Bouferrache
authors.affiliation: 8 Medical Intensive Care Unit, Amiens University Hospital, Amiens, France.
authors.forename: Michel
authors.initials: M
authors.lastname: Slama
authors.affiliation: 6 Medical Intensive Care Unit, Brest University Hospital, Brest, France.
authors.forename: Gwenaël
authors.initials: G
authors.lastname: Prat
authors.affiliation: 4 Intensive Care Unit, Assistance Publique-Hôpitaux de Paris, University Hospital Ambroise Paré, Boulogne-Billancourt, France.|9 Faculty of Medicine Paris Ile-de-France Ouest, University of Versailles Saint-Quentin en Yvelines, Saint-Quentin en Yvelines, France; and.|10 INSERM U-1018, CESP, Team 5, University of Versailles Saint-Quentin en Yvelines, Villejuif, France.
authors.forename: Antoine
authors.initials: A
authors.lastname: Vieillard-Baron
mesh_terms: D000368:Aged; D004452:Echocardiography / Q000379:methods*; D015150:Echocardiography, Doppler; D017548:Echocardiography, Transesophageal; D005260:Female; D005440:Fluid Therapy; D006801:Humans; D008297:Male; D011446:Prospective Studies; D015203:Reproducibility of Results; D012121:Respiration, Artificial; D012680:Sensitivity and Specificity; D014682:Vena Cava, Inferior / Q000000981:diagnostic imaging / Q000503:physiopathology*; D014683:Vena Cava, Superior / Q000000981:diagnostic imaging / Q000503:physiopathology*
keywords: Doppler ultrasonography; echocardiography; fluid therapy; hemodynamic