Volume 14 Supplement 1

30th International Symposium on Intensive Care and Emergency Medicine

Open Access

Distensibility index of inferior vena cava diameter in ventilated septic and trauma patients with shock

  • N Parenti1,
  • D Sangiorgi2,
  • A Pigna3,
  • C Coniglio4,
  • F Cancellieri4,
  • G Gordini4,
  • R Melotti3 and
  • G Di Nino3
Critical Care201014(Suppl 1):P125

DOI: 10.1186/cc8357

Published: 1 March 2010

Introduction

We evaluated the distensibility index of the inferior vena cava (dIVC%) in ventilated septic and trauma patients with shock before and after fluid therapy. There are no data on this index in patients in shock post trauma.

Methods

This is a prospective study conducted in two ICUs between September 2008 and May 2009. Inclusion criteria were: shock (systolic arterial pressure below 90 mmHg and/or perfusion of vasopressor amines) related to severe sepsis or to trauma. The inferior vena cava diameter at end-expiration (IVCDmax) and at end-inspiration (IVCDmin) was measured by echocardiography using a subcostal approach. The distensibility index of the IVC was the ratio of IVCDmax - IVCDmin/IVCDmin expressed as a percentage (dIVC%). Cardiac index (CI) was calculated by analysis of the arterial pressure wave (FloTrac/Vigileo; Edwards). Measurements were performed at baseline and after a volume expansion using 7 ml/kg colloid and 20 ml/kg crystalloid for septic and trauma patients, respectively. Patients were separated into responders (increase in CI ≥15%) and nonresponders (NR) after fluid therapy. The Wilcoxon and Mann-Whitney tests were used to compare paired values. Statistical significance was tested at an α level of 0.05.

Results

Eleven patients in shock (five septic, six trauma; six responder, five NR) were included. The median age was 62 years (range 28 to 78 years) and mean SAPS II score was 52 ± 30 SD. There were no significant differences between responders (R) and NR regarding age, gender, and risk scores. Among all patients, at baseline, median CI and dIVC% were 2.6 l/minute/m2 and 29%, respectively. Volume expansion significantly increased the median CI from 2.6 (2 to 3.3) to 3 (2.1 to 4) l/minute/m2 (P = 0.005) and decreased dIVC% from 29.4% to 12.6% (P = 0.003). The median dIVC% in R was higher than NR: 31.3% vs 17% (P < 0.05). Fluid therapy decreased more dIVC% in R than in NR: R 31% to 12% (P = 0.03), NR 17% to 12% (P = 0.04). The dIVC% showed similar trend in both groups of septic shock (SS) and trauma shock (TS) patients before and after fluid therapy: dIVC% 27% in SS and 24% in TS before fluid therapy; 15% in SS and 11% in TS after therapy.

Conclusions

Our data suggest that dIVC% is a sensitive index of fluid responsive ness in septic and trauma patients in shock. Limitations: few patients.

Authors’ Affiliations

(1)
Hospital Santa Maria della Scaletta Imola
(2)
Università
(3)
Policlinico Sant'Orsola
(4)
Ospedale Maggiore

References

  1. Barbier C, et al.: Respiratory changes in inferior vena cava diameter are helpful in predicting fluid responsiveness in ventilated septic patients. Intensive Care Med 2004, 30: 1740-1746.Google Scholar

Copyright

© BioMed Central Ltd. 2010

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