Intensive Care Medicine

, Volume 30, Issue 9, pp 1834–1837 | Cite as

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

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 responsiveness Echography Inferior vena cava Septic shock Mechanical ventilation 

References

  1. 1.
    Michard F, Teboul JL (2002) Predicting fluid responsiveness in ICU patients. A critical analysis of the evidence. Chest 121:2000–2008PubMedGoogle Scholar
  2. 2.
    Morgan BC, Martin WE, Hornbein TF, Crawford EW, Guntheroth WG (1966) Hemodynamic effects of intermittent positive pressure respiration. Anesthesiology 27:584–590PubMedGoogle Scholar
  3. 3.
    Natori H, Tamaki S, Kira S (1979) Ultrasonographic evaluation of ventilatory effect on inferior vena caval configuration. Am Rev Respir Dis 1979; 120:421–427Google Scholar
  4. 4.
    Perel A (1998) Assessing fluid responsiveness by the systolic pressure variation in mechanically ventilated patients. Anesthesiology 89:1309–1310PubMedGoogle Scholar
  5. 5.
    Tavernier B, Makhotine O, Lebuffe G, Dupont J, Scherpereel P (1998) Systolic pressure variation as a guide to fluid therapy in patients with sepsis-induced hypotension. Anesthesiology 89:1313–1321PubMedGoogle Scholar
  6. 6.
    Michard F, Boussat S, Chemla D, Anguel N, Mercat A, Lecarpentier Y, Richard C, Pinsky MR, Teboul JL (2000) Relation between respiratory changes in arterial pulse pressure and fluid responsiveness in septic patients with acute circulatory failure. Am J Respir Crit Care Med 162:134–138PubMedGoogle Scholar
  7. 7.
    Feissel M, Michard F, Mangin I, Ruyer O, Faller JP, Teboul JL (2001) Respiratory changes in aortic blood velocity as an indicator of fluid responsiveness in ventilated patients with septic shock. Chest 119:867–873PubMedGoogle Scholar
  8. 8.
    Berkenstadt H, Margalit N, Hadani M, Friedman Z, Segal E, Villa Y, Perel A (2001) Stroke volume variation as a predictor of fluid responsiveness in patients undergoing brain surgery. Anesth Analg 92:984–989PubMedGoogle Scholar
  9. 9.
    Reuter DA, Felbinger TW, Schmidt C, Kilger E, Goedje O, Lamm P, Goetz AE (2002) Stroke volume variations for assessment of cardiac responsiveness to volume loading in mechanically ventilated patients after cardiac surgery. Intensive Care Med 28:392–398CrossRefPubMedGoogle Scholar
  10. 10.
    Levy MM, Fink MP, Marshall JC, Abraham E, Angus D, Cook D, Cohen J, Opal SM, Vincent JL, Ramsay G, International sepsis definitions conference (2003) 2001 SCCM/ESICM/ACCP/ATS/SIS International sepsis definitions conference. Intensive Care Med 29:530–538PubMedGoogle Scholar
  11. 11.
    Theres H, Binkau J, Laule M, Heinze R, Hundertmark J, Blobner M, Erhardt W, Baumann G, Stangl K (1999) Phase-related changes in right ventricular cardiac output under volume-controlled mechanical ventilation with positive end-expiratory pressure. Crit Care Med 27:953–958CrossRefPubMedGoogle Scholar
  12. 12.
    Mitaka C, Nagura T, Sakanishi N, Tsunoda Y, Amaha K (1989) Two-dimensional echocardiographic evaluation of inferior vena cava, right ventricle, and left ventricle during positive-pressure ventilation with varying levels of positive end-expiratory pressure. Crit Care Med 17:205–210PubMedGoogle Scholar
  13. 13.
    Magder S, Georgiadis G, Cheong T (1992) Respiratory variations in right atrial pressure predict the response to fluid challenge. J Crit Care 7:76–85Google Scholar
  14. 14.
    Jardin F, Delorme G, Hardy A, Auvert B, Beauchet A, Bourdarias JP (1990) Reevaluation of hemodynamic consequences of positive pressure ventilation: emphasis on cyclic right ventricular afterloading by mechanical lung inflation. Anesthesiology 72:966–970PubMedGoogle Scholar
  15. 15.
    Permutt, S, Howell JB, Proctor DF, Riley RL (1961) Effects of lung inflation on static pressure-volume characteristics of pulmonary vessels. J Appl Physiol 16:64–70PubMedGoogle Scholar
  16. 16.
    Squara P, Dhainaut JF, Schremmer B, Sollet JP, Bleichner G (1990) Decreased paradoxic pulse from increased venous return in severe asthma. Chest 97:377–383PubMedGoogle Scholar
  17. 17.
    Vieillard-Baron A, Augarde R, Prin S, Page B, Beauchet A, Jardin F (2001) Influence of superior vena caval zone condition on cyclic changes in right ventricular outflow during respiratory support. Anesthesiology 95:1083–1088PubMedGoogle Scholar
  18. 18.
    Vieillard-Baron A, Chergui K, Augarde R, Prin S, Page B, Beauchet A, Jardin F (2003) Cyclic changes in arterial pulse during respiratory support revisited by Doppler echocardiography. Am J Respir Crit Care Med 168:671–676CrossRefPubMedGoogle Scholar
  19. 19.
    Amoore JN, Santamore WP (1994) Venous collapse and the respiratory variability in systemic venous return. Cardiovasc Res 28:472–479PubMedGoogle Scholar
  20. 20.
    Michard F, Teboul JL, Richard C (2003) Influence of tidal volume on stroke volume variation. Does it really matter? Intensive Care Med 29:1613CrossRefPubMedGoogle Scholar

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

Personalised recommendations