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

Sepsis is one of the leading causes of death in ICU patients. Fluid resuscitation is the main target in septic patients, but optimal fluid resuscitation for each patient is the true question. 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. Therefore, it is essential to provide adequate fluid resuscitation without “overloading” in order to improve the outcome of the critically ill patients. This requires a careful assessment of the intravascular volume status and fluid responsiveness prior to the institution of fluid therapy. A variety of static and dynamic parameters have been used to assess fluid responsiveness. Static variables, as central venous pressure (CVP), pulse pressure, systolic pressure, and pulmonary artery occlusion pressure (PAOP), were documented as unreliable methods for assessment of fluid responsiveness. Thus dynamic predictors are needed for fluid responsiveness. Our study was conducted on 40 patients spontaneously breathing septic patients according to the surviving sepsis campaign. Patients were chosen randomly in the critical care units in Ain shams university hospitals. Hemodynamic data, ultrasound measures and echo measures of the patients were recorded while patients lying flat in supine position before fluid resuscitation. Fluid resuscitation was done with 7ml/kg crystalloid (Ringer Acetate) over 30 minutes. Echo and ultrasound measures were repeated after fluid resuscitation. Patients were considered responders if change in cardiac index ≥15%.