THE ROLE OF INFERIOR VENA CAVA DIAMETER VARIATION RATIO MEASURED BY ULTRASONOGRAPHY VERSUS CENTRAL VENOUS PRESSURE IN ASSESSMENT OF VOLUME RESPONSIVENESS OF SHOCKED HEPATIC PATIENTS

Abstract

Background: Liver cirrhosis is a major cause of morbidity and mortality in chronic liver disease patients which is multifactorial in nature, leading to several complications including ascites, variceal bleeding, hepatic encephalopathy and hepatorenal syndrome. Aim of the study: to evaluate the relationship between inferior vena cava (IVC) diameter variation ratio measured by ultrasonography (USG) versus central venous pressure as measured via central venous catheter, and whether it is reliable for use in evaluating intravascular volume status during the management of shock in hepatic patients. Patients and Methods: This study included one hundred cirrhotic liver patients with Child-Pugh classification B and C with acute circulatory failure of either sex, aging ≥18 years old, admitted in the ICU at Ain Shams University hospitals. A standard resuscitation strategy was applied. The patients were monitored using mean arterial blood pressure (MAP), heart rate (HR), central venous pressure (CVP) and ultrasound guided IVC collapsibility index (IVCCI) simultaneously at baseline and along the subsequent stages of standard shock management protocol at intervals 1, 4 and 8 hours. Results: The current study showed that 77 patients (77%) responded to volume resuscitation with improvement as regard elevated MAP with maximal mean value of 67.34 (±4.01) mmHg., decreased HR with minimal mean value of 103 (±4.89) b/min., elevated central venous pressure with maximal mean value of 9.05(±2.07) cmH2O and decreased IVC- CI with minimal mean value of 0.64 (±0.05) after 8 hours of volume management, these patientswere considered volume responders., while 23 patients (23%) didn’t respond to volume resuscitation with no response or even deterioration as regard low MAP with maximal mean value of 49.61 (±3.56) mmHg., high HR with minimal mean value of 133 (±4.86) b/min., low central venous pressure with maximal mean value of 2.17 (±0.78) cmH2O and low fixed IVC- CI with minimal mean value of 0.39 (±0.06) after 8 hours of volume management, despite maximal possible volume of fluid resuscitation necessitating use of vasopressor agents, these patients were considered volume non responders.Conclusion: Measurements of CVP and IVC-CI throughout the study in volume responder patients were found to have a solid negative correlation denoting that Inferior Vena Cava collapsibility index assessment is a safe option being non invasive technique and sensitive at least when compared to measuring CVP and to avoid complications of central venous line (CVL) insertion with its complications especially in hepatic patients with coagulopathy.