Stroke volume variation compared with inferior vena cava distensibility for prediction of fluid responsiveness in mechanically ventilated patients with septic shock

Abstract

Background The hemodynamic management of septic shock patients remains a complex challenge. Only 40–72% of intensive care unit (ICU) patients with homodynamic instability are able to respond to fluid loading. We postulated that the variation in vena cava diameter and its correlation to stroke volume variation could also be useful in identifying patients who may benefit from a volume load. The aim of this study was to test stroke volume variation (SVV) as a predictor of fluid responsiveness in mechanically ventilated patients with septic shock and its correlation with inferior vena cava (IVC) distensibility. Patients This prospective study was conducted on 76 adult patients with septic shock on mechanical ventilation. Results The responder and non-responder groups showed areas under the curve 0.963 as regards SVI (2nd) measurements, at the cut off value 36.0 the sensitivity was 97.0, specificity was 95.0, PPV 94.0%, NPV 96.0% and accuracy 95.0 in predicting the response. The SVI (1st) measurements showed areas under the curve 0.963, at the cut off value 8.5 the sensitivity was 95.0, specificity was 98.0, PPV 94.0%, NPV 97.0% and accuracy 96.0 in predicting the response. For Max DIVC within responder and non-responder groups, the areas under the curve 0.884, at the cut off value 2.2 the sensitivity was 82.0, specificity was 85, PPV 86.0%, NPV 83.0% and accuracy 84.0 in predicting the response. Conclusions Stroke volume variation (SVV) can predict fluid responsiveness in mechanically ventilated patients with septic shock and can be correlated to inferior vena cava (IVC) distensibility.