ASSESSMENT OF FLUID RESPONSIVENESS IN PATIENTS WITH ACUTE CIRCULATORY FAILURE USING ECHOCARDIOGRAPHY

Abstract

Background: Predicting fluid responsiveness, the response of stroke volume (SV) to fluid loading, is a relatively novel concept that aims to optimize circulation, and as such organ perfusion, while avoiding futile and potentially deleterious fluid administrations in critically ill patients. Dynamic parameters have shown to be superior in predicting the response to fluid loading compared with static cardiac filling pressures. Passive leg raising (PLR) as a means to alter biventricular preload in combination with subsequent measurement of the change in stroke volume can provide a fast and accurate way to guide fluid management in a broad population of critically ill patients. Objective: To assess the fluid responsiveness in patients with acute circulatory failure using left ventricular outflow variation by 2D echocardiography and inferior vena cava diameter. Patients and Methods: After departmental ethics committee approval and patient consents were obtained, 40 patients included in this work with shock not on mechanical ventilation who were admitted to Critical Care unit of Internal Medicine Department in Al-Hussein Hospital, Al-Azhar University, and The study was carried out during the period from April 2019 to August 2020, 30 patients were responder, and 10 patients were not responder. All patients were subjected to complete history taking, complete physical examination including: arterial blood pressure with mean arterial pressure (MAP) calculation, heart rate (HR), respiratory rate (RR), body temperature (°C). Laboratory investigations included complete blood count (CBC), liver function tests, renal function tests and arterial blood gases (ABGs). In addition, echocardiographic assessment was performed, the left ventricular outflow tract velocity time integral (LVOT) VTI was recorded classically by pulsed wave doppler across LVOT on a 5-chamber apical view, maximum and minimum inferior vena caval DIVC values over a single respiratory cycle were measured before and after (PLR). Results: In the two groups (responder and not responder), 18 (45%) were males and 22 (55%) were females. 22 (55%), 20 (50%), 13 (32.5%), 17 (42.5%), 9(22.5%) were patients with diabetic (DM), hypertensive (HTN), chronic kidney disease (CKD), smoking and on vasoactive drugs respectively, There was no significant difference between the two groups as regard hemodynamic data on admission including temperature, respiratory rate , and pulse rate, There were significant differences between the two groups as regard hemoglobin (Hb), alanine transaminase (ALT), aspartate transaminase (AST) on admission. By echocardiographic parameters, change of velocity time integral ∆VTI % showed significant difference between the two groups with the areas under the curve 0.800, at the cutoff value 3.409. The sensitivity was 90.0, specificity was 70.0, PPV 90.0%, and NPV 70.0% in predict the response. Conclusion: Careful management of volume status and fluid administration is an important determinant of outcomes of the critically ill patients. The change in stroke volume displayed predicted fluid responsiveness in shocked not mechanically ventilated patients with an acceptable sensitivity and specificity than IVC collapsibility Index.