Respiratory changes in inferior vena cava diameter are helpful in predicting fluid responsiveness in ventilated septic patients

Intensive Care Med. 2004 Sep;30(9):1740-6. doi: 10.1007/s00134-004-2259-8. Epub 2004 Mar 18.


Objective: To evaluate the extent to which respiratory changes in inferior vena cava (IVC) diameter can be used to predict fluid responsiveness.

Design: Prospective clinical study.

Setting: Hospital intensive care unit.

Patients: Twenty-three patients with acute circulatory failure related to sepsis and mechanically ventilated because of an acute lung injury.

Measurements: Inferior vena cava diameter (D) at end-expiration (Dmin) and at end-inspiration (Dmax) was measured by echocardiography using a subcostal approach. The distensibility index of the IVC (dIVC) was calculated as the ratio of Dmax - Dmin / Dmin, and expressed as a percentage. The Doppler technique was applied in the pulmonary artery trunk to determine cardiac index (CI). Measurements were performed at baseline and after a 7 ml/kg volume expansion using a plasma expander. Patients were separated into responders (increase in CI > or =15%) and non-responders (increase in CI <15%).

Results: Using a threshold dIVC of 18%, responders and non-responders were discriminated with 90% sensitivity and 90% specificity. A strong relation (r = 0.9) was observed between dIVC at baseline and the CI increase following blood volume expansion. Baseline central venous pressure did not accurately predict fluid responsiveness.

Conclusion: Our study suggests that respiratory change in IVC diameter is an accurate predictor of fluid responsiveness in septic patients.

Publication types

  • Clinical Trial

MeSH terms

  • Adult
  • Aged
  • Blood Pressure
  • Central Venous Pressure
  • Echocardiography, Doppler
  • Heart Function Tests
  • Heart Rate
  • Humans
  • Intensive Care Units
  • Middle Aged
  • Prognosis
  • Prospective Studies
  • Respiration, Artificial
  • Respiratory Insufficiency / etiology
  • Respiratory Insufficiency / physiopathology*
  • Respiratory Insufficiency / therapy
  • Sepsis / complications
  • Sepsis / physiopathology*
  • Sepsis / therapy
  • Vena Cava, Inferior / pathology*
  • Vena Cava, Inferior / physiopathology