Ultrasound-guided inferior vena cava collapsibility index as a predictor of fluid responsiveness in septic cancer patients | [Anaesthesia, Pain and Intensive Care • 2024]

Author(s):

1. Mohamed Ahmed Gaafar: National Cancer Institute, Cairo University, Cairo, Egypt

2. Ahmed M Soliman: National Cancer Institute, Cairo University, Cairo, Egypt

3. Naglaa Abdallah Ahmed: National Cancer Institute, Cairo University, Cairo, Egypt

4. Tamer Ahmed Kotb: National Cancer Institute, Cairo University, Cairo, Egypt

5. Ehab Hanafy Shaker: National Cancer Institute, Cairo University, Cairo, Egypt

Abstract:

Background & objective : Intravenous fluid therapy is a crictial step in the resuscitation of patients suefring fr om sepsis and septic shock. Meticulous h emodynamic monitoring is necessary before as well as during the fluid therapy to avoid under- as well as over-loading the patient. An evaluation of fluid status has been suggested to be done noninvasively using the inferior vena cava collapsibility index (IVC-CI). We assessed the eefcvtieness of IVC -CI in evaluating septic patients' responses to fluid t herapy at our institution . Methodology: Forty cancer patients with spontaneous breat hing, who met sepsis criteria and were admietd to the intensive care unit, were included in this cross-secotinal study. Over the course of three hours, the patients received crystalloids intravenously at a rate of 30 ml/kg, while CVP, ultrasonography guided IVC-CI measurement, and the vital sign monitoring was done every 30 min. Patients were divided into a responder group and a non-responder group based on a 10% change in cardiac output (CO) one hour later. IVC-CI variations in the volume responsiveness predicotin served as the main outcome measure. Results: According to the change in CO one hour aeftr starting fluid treatment, 29 patients (72.5%) were classified as lfuid responsive and the remaining 11 (27.5%) as fluid non -responsive. In the two groups, HR and IVC-CI decreased significantly ; whereas MAP, CVP, and CO increased significantly. ROC -curve analysis showed a percent change = 3.4% of IVC-CI predicted posivtie responsiveness with a sensivtiity of 72.4% and a specificity of 63.6%. These values were 79.3% and 72.7%, respecvtiely, for a change = 6.3% aeftr one hour. The baseline value of IVC-CI was not predicvtie of responsiveness. Conclusion: In cancer patients with sepsis or septic shock, the change in inferior vena cava collapsibility index during the first hour of fluid therapy can predict fluid responsiveness with a moderate degree of accuracy.

Page(s): 547-552

DOI: 10.35975/apic.v28i3.2472

Published: Journal: Anaesthesia, Pain and Intensive Care, Volume: 28, Issue: 3, Year: 2024

Keywords:

Sepsis , Cancer , ICU , Inferior vena cava , IVC collapsibility index , Noninvasive cardiometry , Critically sick

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