Efficacy of Inferior Vena Cava Ultrasound in predicting Fluid Responsiveness in Septic shock patients - A critical Appraisal

Abstract

Background: Fluid resuscitation is a fundamental intervention in managing
septic shock, but accurately assessing fluid respomsiveness is a challenge. IVC
ultrasound offers a non-invasive alternative to evaluate intravascular volume
status, but its efficacy in septic shock patients reuires further evaluation.
Aims and Objectives: To evaluate the effectiveness of dynamic IVC
parameters in predicting fluid responsiveness in septic shock patients, with a
focus on its accuracy, clinical application and potential limitations.
Materials and Methods: This 9-month prospective observational study
conducted in ICU OF Sri Guru Ramdas Institute of medical sciences. This
study includes adult patients aged >18 years diagnosed with septic shock based
on Sepsis 3 criteria( hypotension reuiring vasopressors and serum lactate > 2
mmol/L despite adequate fluid resuscitation).patients with CKD, Right heart
failure and cirrhosis, pregnant patients , with severe arrhythmias were excluded.
Hemodynamic variables, IVC measurements using phased array probe(1-5
MHz) were taken at baseline and 2-hour intervals. Fluid responsiveness was
defined by a ≥15% increase in cardiac output post-fluid challenge. Data were
analyzed using SPSS, with significance set at p < 0.05.
Results: Hemodynamic stability improved over 6 hours, with significant
decreases in heart rate (p < 0.001) and increases in IVC diameters (p < 0.001),
correlating with fluid balance changes. IVC ultrasound effectively predicted
fluid responsiveness in a significant number of patients.
Conclusion: IVC ultrasound is a reliable, non-invasive tool for predicting fluid
responsiveness in septic shock patients with moderate to high sensivity in
spontaneously breathing patients and variable accuracy in mechanically
ventilated individuals. IVC collapsibility and distensibility indices correlate
well with fluid responsiveness but should be alongside other hemodynamic
parameters for optimal decision making.