Validation of echocardiography as predictor of fluid responsiveness in critically ill septic patients

ABSTRACT Background: Dynamic parameters have recently replaced static measures which failed to accurately predict fluid responsiveness (FR) in critically ill patient .Transthoracic echocardiographic (TTE) can be used to non- invasively assess two dynamic parameters to predict fluid responsiveness, subaortic velocity time integral variations (ΔVTI) and respiratory variations of inferior vena-caval diameter (ΔIVCD). The aim of the work is to assess the accuracy of TTE measured variations in aortic blood flow (VTI as a surrogate) and inferior vena-caval diameter with limited bolus colloid infusion in predicting fluid responsiveness in patients with septic shock. Methods: The study included 40 spontaneously breathing patients with acute circulatory failure secondary to septic shock admitted to ICU over 6 months period. Results: TTE measures VTI by Doppler on a 5 chamber apical view, and IVCD in subcostal view in M-mode. Then, 500 ml 6% hydroxyethyl starch (HES) were infused via a specific venous line; the first 100 ml were regularly infused over one minute, the remaining 400 ml were infused at a constant rate over 14 minutes. TTE reassessments were performed after the first minute and after completion of infusion. Patients were classified into two groups, responders and non-responders according to FR, there were a significant difference between responders and non- responders concerning mean VTI after 100 ml fluid infusion (P= 0.003).TTE could accurately predict fluid responsiveness in critically ill septic patient after only 1 minute of colloid infusion by measuring variations of subaortic VTI. Kew word: Septic shock; Fluid challenge; Fluid responsiveness; TTE REFERENCES Barbier C, Loubieres Y et al.(2004) Respiratory changes in inferior vena cava diameter are helpful in predicting fluid responsiveness in ventilated septic patients Intensive Care Medicine :30(9):1740-6. Feissel M, Michard F, Faller JP, Teboul JL. (2004) The respiratory variation in inferior vena cava diameter as a guide to fluid therapy. Intensive Care Med : 30:1834-1837. Heenen S, De Backer D, Vincent JL.(2006) How can the response to volume expansion in patients with spontaneous respiratory movements be predicted? Crit Care :10(4):R102. Michard F, Teboul JL.(2002) Predicting fluid responsiveness in ICU patients: a critical analysis of the evidence .Chest:121:2000-10. Monnet X, Rienzo M, Osman D et al.(2005) Esophageal Doppler monitoring predicts fluid responsiveness in critically ill ventilated patients. Intensive Care Med:31: 1195 -2001. Mouncey PR, Osborn TM, et al.(2015) Trial of early goal-directed resuscitation for septic shock. N Engl J Med : 10:1056. Muller L, Toumi M et al.(2011) An increase in aortic blood flow after an infusion of 100 ml colloid over 1 minute can predict fluid responsiveness: the mini-fluid challenge study. Anesthesiology:115:541-7. Myburgh JA.(2011) Fluid resuscitation in acute illness-time to reappraise the basics. N Engl J Med : 364: 2543-2544 . Shankar Hari M, Phillips G et al.(2016) Assessment of definition and clinical criteria for septic shock. JAMA :315(8):775-87. Sateesh Pujari, & Estari Mamidala. (2015). Anti-diabetic activity of Physagulin-F isolated from Physalis angulata fruits. The American Journal of Science and Medical Research, 1(2), 53–60. https://doi.org/10.5281/zenodo.735230 Slama M, Masson H, Teboul J et al.(2002) Respiratory variations of aortic VTI: A new index of hypovolemia and fluid responsiveness. Am J Physiol Heart Circ Physiol : 283:H1729 –33. Thiele RH, Bartels K, Gan TJ.(2015) Cardiac output monitoring: a contemporary assessment and review. Crit Care Med :43:177–85. Trof RJ, Sukul SP et al.(2010) Greater cardiac response of colloid than saline fluid loading in septic and non-septic critically ill patients with clinical hypovolemia. Intensive Care Med : 36:697–701. Wu Y, Zhou S, Zhou Z, Liu B.(2014) A 10-second fluid challenge guided by transthoracic echocardiography can predict fluid responsiveness. Crit Care : 18: R108