Sensitivity and Specificity of Ultrasound Measured Dimensions of IVC and IJV Compared to Central Venous Pressure in Predicting Fluid Responsiveness,
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- Category: Vol. 84, March 2016
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Sensitivity and Specificity of Ultrasound Measured Dimensions of IVC and IJV Compared to Central Venous Pressure in Predicting Fluid Responsiveness, AHMED M. HASANIN, AHMED M. LOTFY, IMAN R. ABD EL-AAL, JIHAN EL-KHOLY, MAHMOUD S. SOLIMAN and HANAN M. MOSTAFA
Abstract
Background: Prediction of Fluid Responsiveness (FR) is a critical step in management of patients with septic shock. Using ultrasound in detection of Inferior Vena Cava (IVC) diameters and collapsibility is established in mechanically ventilated patients; however its use in spontaneous breathing patients is still controversial. Few studies reported a correlation between internal jugular vein dimensions and Central Venous Pressure (CVP) but no data are available about the use IJV dimensions in detection of FR.
Objective: The aim of our study is to determine the possible rule of IVC diameters, collapsibility, and IJV dimen-sions in prediction of FR in spontaneous breathing patients.
Methods: Forty spontaneously breathing patients with septic shock were included in the study. Ultrasound examina-tion was done before fluid resuscitation. IVC minimal and maximum diameters, IVC caval index (IVC maximum IVC minimum/IVC maximum), IJV aspect ratio (IJV vertical diameter/IJV transverse diameter) were measured before fluid resuscitation. Transthoracic Echocardiography (TTE) was done to determine Fluid Responsiveness (FR) which was defined as increase in subaortic Velocity Time Integral (VTI) >15% after fluid bolus. Sensitivity, specificity and Area Under Receiver Operating Characteristic (AUROC) curves were determined for all ultrasound parameters as well as CVP for detection of FR.
Results: Twenty six patients (65%) were fluid responders. AUROC (95% CI) for prediction of FR was: 0.57 (0.3-0.84) for CVP, and 0.64 (0.4-0.88) for IVC maximum diameter. AUROC (95% CI) was 0.93 (0.83-1.00) for IJV minimum diameter with a sensitivity and specificity of 100% and 70% respectively at a cut-off value of 0.9cm and was 0.96 (0.89- 1.00) for caval index with a sensitivity and specificity of 92% and 86% respectively at a cut-off value of 35%. AUROC for IJV aspect ratio 0.53 (0.24-0.82).
Conclusions: IVC minimum diameter anc caval index are useful methods to predicted FR in spontaneousely breathing patientswith septic shock.