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Critical Care

, 14:P125 | Cite as

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

  • N Parenti
  • D Sangiorgi
  • A Pigna
  • C Coniglio
  • F Cancellieri
  • G Gordini
  • R Melotti
  • G Di Nino
Poster presentation

Keywords

Septic Shock Arterial Pressure Severe Sepsis Trauma Patient Cardiac Index 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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.

References

  1. 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 information

© BioMed Central Ltd. 2010

Authors and Affiliations

  • N Parenti
    • 1
  • D Sangiorgi
    • 2
  • A Pigna
    • 3
  • C Coniglio
    • 4
  • F Cancellieri
    • 4
  • G Gordini
    • 4
  • R Melotti
    • 3
  • G Di Nino
    • 3
  1. 1.Hospital Santa Maria della Scaletta ImolaBolognaItaly
  2. 2.UniversitàBolognaItaly
  3. 3.Policlinico Sant'OrsolaBolognaItaly
  4. 4.Ospedale MaggioreBolognaItaly

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