Transthoracic echocardiographic assessment of IVC diameter variability to determine fluid responsiveness in children with septic shock: a pilot study

Abstract

Background and aims: Fluid therapy is one of the most ubiquitous interventions in acute care practice, especially in children presenting in septic shock. A good prediction of fluid responsive state would help us to achieve precise hemodynamic balance and to avoid adverse effects of fluid overload. Aims: To evaluate the degree of IVC diameter variability in predicting fluid responsiveness (increment in stroke volume >= 15%) in children with septic shock post 20 ml/kg of crystalloid (0.9% saline) resuscitation. Methods: Study design: Prospective Observational Study: 166 episodes of "Preload Responsiveness Check" were echocardiographically evaluated in 41 children with septic shock. In each episode, IVC diameter variability, stroke volumes were assessed at two points (Before preload T0 and after preload T1) after adequate sedation. Children were enrolled in the study after informed consent from parents. Results: Of the 166 episodes, 120 (72%) were fluid responsive and 46 (28%) were non-responsive. IVC diameter variability at T0 correlated significantly (r = 0.39; p=0.001) with stroke volume increment following preload. AUC of ROC for IVC diameter variability was 0.75 (0.66 - 0.85). A cut off value of 14 % variability showed 84.4% sensitivity and 65.9% specificity to positively predict fluid responsiveness in ventilated as well in spontaneously breathing children. Conclusions: IVC diameter variability can act as a useful bedside tool in predicting preload responsiveness in children with septic shock. Utility of serial?IVC % instead of single measurement to assess volume changes need to be explored.