Intensive Care Medicine

, Volume 30, Issue 9, pp 1834–1837

The respiratory variation in inferior vena cava diameter as a guide to fluid therapy

  • Marc Feissel
  • Frédéric Michard
  • Jean-Pierre Faller
  • Jean-Louis Teboul
Brief Report

DOI: 10.1007/s00134-004-2233-5

Cite this article as:
Feissel, M., Michard, F., Faller, J. et al. Intensive Care Med (2004) 30: 1834. doi:10.1007/s00134-004-2233-5

Abstract

Objective

To investigate whether the respiratory variation in inferior vena cava diameter (ΔDIVC) 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 ΔDIVC 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 ΔDIVC 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 ΔDIVC 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% ΔDIVC cut-off value allowed identification of responders with positive and negative predictive values of 93% and 92%, respectively.

Conclusion

Analysis of ΔDIVC is a simple and non-invasive method to detect fluid responsiveness in mechanically ventilated patients with septic shock.

Keywords

Fluid responsivenessEchographyInferior vena cavaSeptic shockMechanical ventilation

Copyright information

© Springer-Verlag 2004

Authors and Affiliations

  • Marc Feissel
    • 1
  • Frédéric Michard
    • 2
  • Jean-Pierre Faller
    • 1
  • Jean-Louis Teboul
    • 3
  1. 1.Réanimation médicale et maladies infectieusesCentre hospitalier de BelfortBelfortFrance
  2. 2.Department of Anesthesia and Critical Care, Massachusetts General HospitalHarvard Medical SchoolBostonUSA
  3. 3.Réanimation médicale, Bicêtre hospitalParis Sud Medical SchoolLe Kremlin BicêtreFrance