Echocardiography for left ventricular outflow tract velocity time integral versus inferior vena cava collapsibility index as a predictor to fluid responsiveness in severe sepsis

Abstract

Abstract Background Severe sepsis is the most common cause of death for patients admitted to the critical care units. Sepsis is a multifaceted host response to an infecting pathogen that may be significantly amplified by endogenous factors. Sepsis is defined as life-threatening organ dysfunction caused by a dysregulated host response to infection. This emphasizes the primacy of the non-homeostatic host-response to infection, the potential lethality that is considerably in excess of a straightforward infection, and the need for urgent recognition. Aims The aim of this work is to compare Left ventricular Outflow Tract (LVOT) velocity time Integral (VTI) and inferior Vena Cava (IVC) collapsibility index as a predictor to fluid responsiveness in patients with severe sepsis and septic shock. Methodology This study was conducted on 40 patients of both sex who were admitted to the intensive care unit were diagnosed as severe sepsis and /or septic shock. Patients were divided in two groups: Responders (R): 22 patients with LVOT ΔVTI 500 ≥ 15%. Non-responders (NR): 18 patients with LVOT ΔVTI 500 < 15%. Results Our results showed that IVCCI 100 and 500 were a less reliable predictor to fluid responsiveness in patients with severe sepsis and septic shock than ΔVTI 500. However when using IVCCI after 100 or 500 cc of fluid resuscitation, patients with IVCCI 100 above 38% or IVCCI 500 above 30% are more likely to respond to fluid challenge. More precisely, an IVCCI 100 below 38% and IVCCI 500 value below 30% cannot exclude fluid responsiveness. Conclusions IVC collapsibility Index is less reliable predictor than VTI (LVOT) in predicting fluid responsiveness in spontaneously breathing patients diagnosed with severe sepsis and/ or septic shock Recommendations IVCCI should be used more cautiously as a predictor to fluid responsiveness in spontaneously breathing patients diagnosed with severe sepsis and /or septic shock.