Author/Authors :
HASANIN, AHMED M. Cairo University Hospitals - Faculty of Medicine - Department of Anesthesia Intensive Care, Egypt , LOTFY, AHMED M. Cairo University Hospitals - Faculty of Medicine - Department of Anesthesia Intensive Care, Egypt , ABD EL-AAL, IMAN R. Cairo University Hospitals - Faculty of Medicine - Department of Anesthesia Intensive Care, Egypt , EL-KHOLY, JIHAN Cairo University Hospitals - Faculty of Medicine - Department of Anesthesia Intensive Care, Egypt , SOLIMAN, MAHMOUD S. Cairo University Hospitals - Faculty of Medicine - Department of Anesthesia Intensive Care, Egypt , MOSTAFA, HANAN M. Cairo University Hospitals - Faculty of Medicine - Department of Anesthesia Intensive Care, Egypt
Abstract :
Background: Prediction of Fluid Responsiveness (FR) is a critical step in management of patients with septic shock. Using ultrasound in detection of Inferior Vena Cava (IVC) diameters and collapsibility is established in mechanically ventilated patients; however its use in spontaneous breathing patients is still controversial. Few studies reported a correlation between internal jugular vein dimensions and Central Venous Pressure (CVP) but no data are available about the use IJV dimensions in detection of FR.Objective: The aim of our study is to determine the possible rule of IVC diameters, collapsibility, and IJV dimensions in prediction of FR in spontaneous breathing patients.Methods: Forty spontaneously breathing patients with septic shock were included in the study. Ultrasound examination was done before fluid resuscitation. IVC minimal and maximum diameters, IVC caval index (IVC maximum IVC minimum/IVC maximum), IJV aspect ratio (IJV vertical diameter/IJV transverse diameter) were measured before fluid resuscitation. Transthoracic Echocardiography (TTE) was done to determine Fluid Responsiveness (FR) which was defined as increase in subaortic Velocity Time Integral (VTI) 15% after fluid bolus. Sensitivity, specificity and Area Under Receiver Operating Characteristic (AUROC) curves were determined for all ultrasound parameters as well as CVP for detection of FR.Results: Twenty six patients (65%) were fluid responders. AUROC (95% CI) for prediction of FR was: 0.57 (0.3-0.84) for CVP, and 0.64 (0.4-0.88) for IVC maximum diameter. AUROC (95% CI) was 0.93 (0.83-1.00) for IJV minimum diameter with a sensitivity and specificity of 100% and 70% respectively at a cut-off value of 0.9cm and was 0.96 (0.89- 1.00) for caval index with a sensitivity and specificity of 92% and 86% respectively at a cut-off value of 35%. AUROC for IJV aspect ratio 0.53 (0.24-0.82).Conclusions: IVC minimum diameter anc caval index are useful methods to predicted FR in spontaneousely breathing patientswith septic shock.
