The respiratory variation in inferior vena cava diameter as a guide to fluid therapy |
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Authors: | Marc?Feissel Email author" target="_blank">Frédéric?MichardEmail author Jean-Pierre?Faller Jean-Louis?Teboul |
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Institution: | (1) Réanimation médicale et maladies infectieuses, Centre hospitalier de Belfort, Belfort, France;(2) Department of Anesthesia and Critical Care, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA 02114, USA;(3) Réanimation médicale, Bicêtre hospital, Paris Sud Medical School, Le Kremlin Bicêtre, France |
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Abstract: | Objective To investigate whether the respiratory variation in inferior vena cava diameter (DIVC) could be related to fluid responsiveness in mechanically ventilated patients.Design Prospective clinical study.Setting Medical ICU of a non-university hospital.Patients Mechanically ventilated patients with septic shock (n=39).Interventions Volume loading with 8 mL/kg of 6% hydroxyethylstarch over 20 min.Measurements and results Cardiac output and DIVC were assessed by echography before and immediately after the standardized volume load. Volume loading induced an increase in cardiac output from 5.7±2.0 to 6.4±1.9 L/min (P<0.001) and a decrease in DIVC from 13.8±13.6 vs 5.2±5.8% (P<0.001). Sixteen patients responded to volume loading by an increase in cardiac output 15% (responders). Before volume loading, the DIVC was greater in responders than in non-responders (25±15 vs 6±4%, P<0.001), closely correlated with the increase in cardiac output (r=0.82, P<0.001), and a 12% DIVC cut-off value allowed identification of responders with positive and negative predictive values of 93% and 92%, respectively.Conclusion Analysis of DIVC is a simple and non-invasive method to detect fluid responsiveness in mechanically ventilated patients with septic shock. |
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Keywords: | Fluid responsiveness Echography Inferior vena cava Septic shock Mechanical ventilation |
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