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CC BY 4.0 · Journal of Child Science 2021; 11(01): e49-e54
DOI: 10.1055/s-0041-1724034
Original Article

Role of Inferior Vena Cava Parameters as Predictors of Fluid Responsiveness in Pediatric Septic Shock: A Prospective Study

Ahmed Ahmed EL-Nawawy
1   Pediatric Intensive Care Unit, Department of Pediatrics, Faculty of Medicine, Alexandria University, Egypt
,
Omneya Magdy Omar
2   Department of Pediatrics, Faculty of Medicine, Alexandria University, Egypt
,
Hadir Mohamed Hassouna
1   Pediatric Intensive Care Unit, Department of Pediatrics, Faculty of Medicine, Alexandria University, Egypt
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Abstract

Fluid resuscitation is the initial therapy for septic shock worldwide. Prediction of fluid responsiveness is essential for optimizing fluid administration. Only few pediatric studies have evaluated the role of inferior vena cava (IVC) as a reliable predictor of fluid responsiveness. The aim of this study was to evaluate the role of IVC parameters as predictors of fluid responsiveness in children (under the age of 5 years) having septic shock at different times from admission. A prospective observational study included 51 children having septic shock. It was conducted in the nine-bedded pediatric intensive care unit of a university hospital from January 1, 2018, to the August 31, 2018. Echocardiography was used to assess minimal and maximal IVC diameters and its distensibility index with simultaneous assessment of stroke volume (SV), at 1, 6, and 24 hours from admission. The decision to give fluid in these children was thereby based on the presence of at least one sign of inadequate tissue perfusion. SV was reassessed directly after administration of a fluid bolus of 10 mL/kg over 10 minutes. Fluid responsiveness was considered adequate when there was ≥ 10% increase in SV after fluid bolus. Minimal IVC diameter indexed to body surface area and its distensibility index can be predictors of fluid responsiveness at all times: 1 hour (area under curve [AUC] = 0.88; 95% confidence interval [CI] = 0.77–0.96), 6 hours (AUC = 0.86; 95% CI = 0.67–0.97), and 24 hours (AUC = 0.77; 95% CI = 0.6–0.95). IVC distensibility index can also predict fluid responsiveness at 1 hour (AUC= 0.87; 95% CI = 0.74–0.95), 6 hours (AUC = 0.86; 95% CI = 0.73–0.94), and 24 hours (AUC = 1; 95% CI = 0.77–1). The cutoff points of each parameter differed from time to time (contradicts with previous statement that says it is predictor at all times). The maximum IVC diameter could not predict fluid responsiveness at any time from admission. Minimal IVC diameter and its distensibility index were feasible noninvasive surrogates of fluid responsiveness in pediatric septic shock at different times from admission.

Keywords

distensibility index - echocardiography - fluid responsiveness - inferior vena cava - pediatric septic shock


Publication History

Received: 12 October 2020

Accepted: 12 January 2021

Article published online:
19 February 2021

© 2021. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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  • References

  • 1 Long E, Oakley E, Duke T, Babl FE. Paediatric Research in Emergency Departments International Collaborative (PREDICT). Does respiratory variation in inferior vena cava diameter predict fluid responsiveness: a systematic review and meta-analysis?. Shock 2017; 47 (05) 550-559
    CrossrefPubMedGoogle Scholar
  • 2 Kelm DJ, Perrin JT, Cartin-Ceba R, Gajic O, Schenck L, Kennedy CC. Fluid overload in patients with severe sepsis and septic shock treated with early goal-directed therapy is associated with increased acute need for fluid-related medical interventions and hospital death. Shock 2015; 43 (01) 68-73
    CrossrefPubMedGoogle Scholar
  • 3 Kathuria N, Ng L, Saul T, Lewiss RE. The baseline diameter of the inferior vena cava measured by sonography increases with age in normovolemic children. J Ultrasound Med 2015; 34 (06) 1091-1096
    CrossrefPubMedGoogle Scholar
  • 4 Dipti A, Soucy Z, Surana A, Chandra S. Role of inferior vena cava diameter in assessment of volume status: a meta-analysis. Am J Emerg Med 2012; 30 (08) 1414-1419.e1
    CrossrefPubMedGoogle Scholar
  • 5 Corl K, Napoli AM, Gardiner F. Bedside sonographic measurement of the inferior vena cava caval index is a poor predictor of fluid responsiveness in emergency department patients. Emerg Med Australas 2012; 24 (05) 534-539
    CrossrefPubMedGoogle Scholar
  • 6 Orso D, Paoli I, Piani A. et al. Accuracy of ultrasonographic measurements of inferior vena cava to determine fluid responsiveness: a systematic review and meta-analysis. J Intensive Care Med 2018; DOI: 10.1177/0885066617752308.
    CrossrefPubMedGoogle Scholar
  • 7 Abu-Zidan FM. Optimizing the value of measuring inferior vena cava diameter in shocked patients. World J Crit Care Med 2016; 5 (01) 7-11
    CrossrefPubMedGoogle Scholar
  • 8 El-Nawawy AA, Abdelmohsen AM, Hassouna HM. Role of echocardiography in reducing shock reversal time in pediatric septic shock: a randomized controlled trial. J Pediatr (Rio J) 2018; 94 (01) 31-39
    CrossrefPubMedGoogle Scholar
  • 9 Baker EC, Pott J, Khan F, Freund Y, Harris T. Best approach to measuring the inferior vena cava in spontaneously ventilating patients: a pilot study. Eur J Emerg Med 2015; 22: 58-61
    CrossrefPubMedGoogle Scholar
  • 10 Seif D, Mailhot T, Perera P, Mandavia D. Caval sonography in shock: a noninvasive method for evaluating intravascular volume in critically ill patients. J Ultrasound Med 2012; 31 (12) 1885-1890
    CrossrefPubMedGoogle Scholar
  • 11 Lang RM, Badano LP, Mor-Avi V. et al. Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. Eur Heart J Cardiovasc Imaging 2015; 16 (03) 233-270
    CrossrefPubMedGoogle Scholar
  • 12 Plant V, Vanguri P, Anand R, Haynes J, Aboutanos M, Ferrada P. Image-guided resuscitation with limited transthoracic echocardiogram in pediatric trauma patients. Pediatr Emerg Care 2018; 34 (02) 121-124
    CrossrefPubMedGoogle Scholar
  • 13 Charan J, Biswas T. How to calculate sample size for different study designs in medical research?. Indian J Psychol Med 2013; 35 (02) 121-126
    CrossrefPubMedGoogle Scholar
  • 14 Goldstein B, Giroir B, Randolph A. International Consensus Conference on Pediatric Sepsis. International pediatric sepsis consensus conference: definitions for sepsis and organ dysfunction in pediatrics. Pediatr Crit Care Med 2005; 6 (01) 2-8
    CrossrefPubMedGoogle Scholar
  • 15 Brierley J, Carcillo JA, Choong K. et al. Clinical practice parameters for hemodynamic support of pediatric and neonatal septic shock: 2007 update from the American College of Critical Care Medicine. Crit Care Med 2009; 37 (02) 666-688
    CrossrefPubMedGoogle Scholar
  • 16 Dellinger RP, Levy MM, Rhodes A. et al; Surviving Sepsis Campaign Guidelines Committee including The Pediatric Subgroup. Surviving Sepsis Campaign: international guidelines for management of severe sepsis and septic shock, 2012. Intensive Care Med 2013; 39 (02) 165-228
    CrossrefPubMedGoogle Scholar
  • 17 Barbier C, Loubières Y, Schmit C. et al. Respiratory changes in inferior vena cava diameter are helpful in predicting fluid responsiveness in ventilated septic patients. Intensive Care Med 2004; 30 (09) 1740-1746
    CrossrefPubMedGoogle Scholar
  • 18 Miller A, Mandeville J. Predicting and measuring fluid responsiveness with echocardiography. Echo Res Pract 2016; 3 (02) G1-G12
    CrossrefPubMedGoogle Scholar
  • 19 Assadi F. Passive leg raising: simple and reliable technique to prevent fluid overload in critically ill patients. Int J Prev Med 2017; 8 (01) 48
    CrossrefPubMedGoogle Scholar
  • 20 Vieillard-Baron A, Caille V, Charron C, Belliard G, Page B, Jardin F. Actual incidence of global left ventricular hypokinesia in adult septic shock. Crit Care Med 2008; 36 (06) 1701-1706
    CrossrefPubMedGoogle Scholar
  • 21 Boyd JH, Sirounis D, Maizel J, Slama M. Echocardiography as a guide for fluid management. Crit Care 2016; 20: 274-280
    CrossrefPubMedGoogle Scholar
  • 22 Yildizdas D, Aslan N. Ultrasonographic inferior vena cava collapsibility and distensibility indices for detecting the volume status of critically ill pediatric patients. J Ultrason 2020; 20 (82) e205-e209
    CrossrefPubMedGoogle Scholar
  • 23 Ilyas A, Ishtiaq W, Assad S. et al. Correlation of IVC diameter and collapsibility index with central venous pressure in the assessment of intravascular volume in critically ill patients. Cureus 2017; 9 (02) e1025
    PubMedGoogle Scholar
  • 24 Zhang Z, Xu X, Ye S, Xu L. Ultrasonographic measurement of the respiratory variation in the inferior vena cava diameter is predictive of fluid responsiveness in critically ill patients: systematic review and meta-analysis. Ultrasound Med Biol 2014; 40 (05) 845-853
    CrossrefPubMedGoogle Scholar
  • 25 Bilgili B, Haliloglu M, Tugtepe H, Umuroglu T. The assessment of intravascular volume with inferior vena cava and internal jugular vein distensibility indexes in children undergoing urologic surgery. J Invest Surg 2018; 31 (06) 523-528
    CrossrefPubMedGoogle Scholar
  • 26 Basu S, Sharron M, Herrera N, Mize M, Cohen J. Point of care ultrasound assessment of the inferior vena cava in mechanically ventilated critically ill children. J Ultrasound Med 2020; 39 (08) 1573-1579
    CrossrefPubMedGoogle Scholar