Internal jugular vein distensibility variation and inferior vena cava collapsibility variation with fluid resuscitation as an indicator for fluid management in spontaneously breathing septic patients

Abstract

Abstract Background Sepsis is one of the leading causes of death in ICU patients. Fluid resuscitation is the main target in septic patients. Proper fluid administration is needed in septic patients to overcome generalized vasodilatation and capillary leak, this capillary leak itself may cause tissue edema and worsen septic patients. On the other hand, vasopressors may improve tissue perfusion or worsen tissue hypoxia. Therefore, predictors for fluid responsiveness are urgently needed. However, many studies have found static indicators useless. That is why dynamic predictors for fluid responsiveness are attracting growing interest to optimize patients. Our goal is to assess the predictive power of internal jugular vein distensibility index and inferior vena cava collapsibility index for fluid responsiveness in spontaneously breathing septic patients. Forty adult septic patients were enrolled from a single university teaching hospital’s ICU. We measured the Internal jugular distensibility index (IJV-DI) and Inferior vena cava collapsibility index (IVC-CI) in spontaneously breathing septic patients. Patients were considered responders if they had a change in cardiac index (≥ 15%) after fluid resuscitation with 7 ml/kg crystalloid. The main outcome measure is predictive power of Internal jugular vein distensibility index and Inferior vena cava collapsibility index. Results Data from 40 spontaneously breathing septic patients were analyzed. Sixty percent of the patients were fluid responder. The areas under curve of receiver operating characteristic for Internal jugular vein distensibility index and Inferior vena cava collapsibility index to predict fluid responsiveness were 0.96 and 0.97, respectively. IJV-DI (> 17.56%) was predictive of fluid responsiveness with 95.83% sensitivity and 87.5% specificity. IVC-CI (> 35%) was predictive of fluid responsiveness with 95.8% sensitivity and 93.7% specificity. Conclusions Both IJV-DI and IVC-CI have near good predictive value for fluid responsiveness in spontaneously breathing septic patients.