Intensive Care Medicine

, Volume 30, Issue 9, pp 1740–1746 | Cite as

Respiratory changes in inferior vena cava diameter are helpful in predicting fluid responsiveness in ventilated septic patients

  • Christophe Barbier
  • Yann Loubières
  • Christophe Schmit
  • Jan Hayon
  • Jean-Louis Ricôme
  • François Jardin
  • Antoine Vieillard-Baron



To evaluate the extent to which respiratory changes in inferior vena cava (IVC) diameter can be used to predict fluid responsiveness.


Prospective clinical study.


Hospital intensive care unit.


Twenty-three patients with acute circulatory failure related to sepsis and mechanically ventilated because of an acute lung injury.


Inferior vena cava diameter (D) at end-expiration (Dmin) and at end-inspiration (Dmax) was measured by echocardiography using a subcostal approach. The distensibility index of the IVC (dIVC) was calculated as the ratio of Dmax − Dmin / Dmin, and expressed as a percentage. The Doppler technique was applied in the pulmonary artery trunk to determine cardiac index (CI). Measurements were performed at baseline and after a 7 ml/kg volume expansion using a plasma expander. Patients were separated into responders (increase in CI ≥15%) and non-responders (increase in CI <15%).


Using a threshold dIVC of 18%, responders and non-responders were discriminated with 90% sensitivity and 90% specificity. A strong relation (r=0.9) was observed between dIVC at baseline and the CI increase following blood volume expansion. Baseline central venous pressure did not accurately predict fluid responsiveness.


Our study suggests that respiratory change in IVC diameter is an accurate predictor of fluid responsiveness in septic patients.


Inferior vena cava Central venous pressure Echocardiography Sepsis Fluid responsiveness Mechanical ventilation 


  1. 1.
    Weil MH, Nishjima (1978) Cardiac output in bacterial shock. Am J Med 64:920–922PubMedGoogle Scholar
  2. 2.
    Murakawa K, Kobayashi A (1988) Effect of vasopressors on renal tissue gas tensions during hemorrhagic shocks in dogs. Crit Care Med 16:789–792PubMedGoogle Scholar
  3. 3.
    Magder S (1992) Shock physiology. In: Pinsky MR, Dhainault JF (eds) Physiological foundation of critical care medicine. Williams and Wilkins, Philadelphia, pp 140–160Google Scholar
  4. 4.
    Guyton AC, Jones CE, Coleman TG (1973) Circulatory physiology: cardiac output and its regulation. Saunders, PhiladelphiaGoogle Scholar
  5. 5.
    Michard F, Teboul JL (2002) Predicting fluid responsiveness in ICU patients. A critical analysis of the evidence. Chest 121:2000–2008PubMedGoogle 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.
    Comolet R (1984) Biomécanique Circulatoire. Abrégé Masson, pp 36–53Google Scholar
  8. 8.
    American College of Chest Physicians/Society of Critical Care Medicine Consensus conference (1992) Definitions for sepsis and organ failure and guidelines for use of innovative therapies in sepsis (review). Crit Care Med 27:864–874Google Scholar
  9. 9.
    Fusco MA, Shayn Martin R, Chang MC (2001) Estimation of intra-abdominal pressure by bladder pressure measurement: validity and methodology. J Trauma 50:297–302PubMedGoogle Scholar
  10. 10.
    Maslow A, Comunale ME, Haering JM, Watkins J (1996) Pulsed wave Doppler measurement of cardiac output from the right ventricular outflow tract. Anesth Analg 83:466–471PubMedGoogle Scholar
  11. 11.
    Calvin JE, Driedger AA, Sibbald WJ (1981) The hemodynamic effect of rapid fluid infusion in critically ill patients. Surgery 90:61–76PubMedGoogle Scholar
  12. 12.
    Reuse C, Vincent JL, Pinsky MR (1990) Measurements of right ventricular volumes during fluid challenge. Chest 98:1450–1454PubMedGoogle Scholar
  13. 13.
    Natori H, Tamaki S, Kira S (1979) Ultrasonographic evaluation of ventilatory effect on inferior vena caval configuration. Am Rev Respir Dis 120:421–427PubMedGoogle Scholar
  14. 14.
    Jeffrey RB, Federle MP (1988) The collapsed inferior vena cava: CT evidence of hypovolemia. Am J Roentgen 150:431–432Google Scholar
  15. 15.
    Nakao S, Come P, Mckay RG, Ransil BJ (1987) Effect of positional changes on inferior vena caval size and dynamics and correlation with right-sided cardiac pressure. Am J Cardiol 59:125–132PubMedGoogle Scholar
  16. 16.
    Takata M, Wise RA, Robotham JL (1990) Effect of abdominal pressure on venous return: abdominal vascular zone conditions. J Appl Physiol 69:1961–1972PubMedGoogle Scholar
  17. 17.
    Jardin F, Dubourg O, Margairaz A, Bourdarias JP (1987) Inspiratory impairment in right ventricular performance during acute asthma. Chest 92:789–795PubMedGoogle Scholar
  18. 18.
    Kircher BJ, Himelman RB, Schiller NB (1990) Noninvasive estimation of right atrial pressure from the inspiratory collapse of the inferior vena cava. Am J Cardiol 66:493–496PubMedGoogle Scholar
  19. 19.
    Nagueh SF, Kopelen HA, Zoghbi WA (1996) Relation of mean right atrial pressure to echocardiographic and Doppler parameters of the right atrial and right ventricular function. Circulation 93:1160–1169PubMedGoogle Scholar
  20. 20.
    Jue J, Chung W, Schiller NB (1992) Does inferior vena cava size predict right atrial pressures in patients receiving mechanical ventilation? J Am Soc Echocardiogr 5:613–619PubMedGoogle Scholar
  21. 21.
    Mitaka C, Nagura T, Sakanishi N, Tsunoda Y, Amaha K (1989) Two-dimensional echographic evaluation of inferior vena cava, right and left ventricle during positive-pressure ventilation with varying level of positive end-expiratory pressure. Crit Care Med 17:205–210PubMedGoogle Scholar
  22. 22.
    Van Den Berg PC, Jansen JRC, Pinsky MR (2002) Effect of positive pressure on venous return in volume-loaded surgical patients. J Appl Physiol 92:1223–1231Google Scholar
  23. 23.
    Antunes T, Anbar J, Barbas C (2003) Effects of PEEP and external abdominal weight on respiratory mechanics. Intensive Care Med 28:S34Google Scholar
  24. 24.
    Jardin F, Genevray B, Brun-Ney D, Bourdarias JP (1985) Influence of lung and chest wall compliance on transmission of airway pressure to the pleural space in critically ill patients. Chest 88:653–658PubMedGoogle Scholar
  25. 25.
    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
  26. 26.
    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

Copyright information

© Springer-Verlag 2004

Authors and Affiliations

  • Christophe Barbier
    • 1
  • Yann Loubières
    • 1
  • Christophe Schmit
    • 1
  • Jan Hayon
    • 1
  • Jean-Louis Ricôme
    • 1
  • François Jardin
    • 2
  • Antoine Vieillard-Baron
    • 2
  1. 1.Medical and Surgical Intensive Care UnitHospital St. Germain-en-LayeSt Germain-en-LayeFrance
  2. 2.Medical Intensive Care UnitUniversity Hospital Ambroise Paré, Assistance Publique Hôpitaux de ParisBoulogne CedexFrance

Personalised recommendations