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Comparison of Echocardiographic Indices Used to Predict Fluid Responsiveness in Ventilated Patients.

Abstract
Assessment of fluid responsiveness relies on dynamic echocardiographic parameters which have not yet been compared in large cohorts. To determine the diagnostic accuracy of dynamic parameters used to predict fluid responsiveness in ventilated patients with a circulatory failure of any cause. In this multicenter prospective study, respiratory variations of superior vena cava diameter (∆SVC) measured using transesophageal echocardiography, of inferior vena cava diameter (∆IVC) measured using transthoracic echocardiography, of the maximal Doppler velocity in left ventricular outflow tract (∆VmaxAo) measured using either approach, and pulse pressure variations (∆PP) were recorded with the patient in the semi-recumbent position. In each patient, a passive leg raise was performed and an increase of aortic velocity time integral ≥ 10% defined fluid responsiveness. Among 540 patients (379 men; age: 65±13 years; SAPSII: 59±18; SOFA: 10±3), 229 exhibited fluid responsiveness (42%). ∆PP, ∆VmaxAo, ∆SVC, and ∆IVC could be measured in 78.5%, 78.0%, 99.6%, and 78.1% of cases, respectively. ∆SVC ≥ 21%, ∆VmaxAo ≥ 10% and ∆IVC ≥ 8% had a sensitivity of 61% (95% confidence intervals: 57-66%), 79% (75-83%) and 55% (50-59%), respectively, and a specificity of 84% (81-87%), 64% (59-69%), and 70% (66-75%), respectively. The area under the Receiver Operating Characteristic curve of ∆SVC was significantly greater than that of ∆IVC (p=0.02) and ∆PP (p=0.01). ∆VmaxAo had the best sensitivity and ∆SVC the best specificity in predicting fluid responsiveness. ∆SVC had a greater diagnostic accuracy than ∆IVC and ∆PP but its measurement requires transesophageal echocardiography.

PMID: 27653798 [Pubmed - Publisher]

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