Critical Care: Critical Care: Mechanical Ventilation |

Velocity Time Integral (VTI) Is a Reliable Surrogate of Fluid Responsiveness in Mechanically Ventilated Patients With Severe Sepsis FREE TO VIEW

Alai Taggu, MD; Kiran Gudivada, MD; Jerry Thomas, MD; Shashidhar Patil, MD
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St. Johns Medical College Hospital, Bangalore, India

Copyright 2016, American College of Chest Physicians. All Rights Reserved.

Chest. 2016;149(4_S):A166. doi:10.1016/j.chest.2016.02.172
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SESSION TITLE: Critical Care: Mechanical Ventilation

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Saturday, April 16, 2016 at 11:45 AM - 12:45 PM

PURPOSE: This study was to assess the changes in Velocity time integral (VTI Aortic) as a surrogate of stroke volum induced by PLR measured with TTE as an indicator of fluid responsiveness in mechanically ventilated patients with severe sepsis.

METHODS: Hundred and eighteen mechanically ventilated patients with severe sepsis admitted in the mixed ICU of a tertiary level South Indian Hospital between 2012 July to June 2013 were considered. Patients with non-sinus rhythm, pregnancy, raised ICP and suspected spine injury were excluded. Measurements were obtained supine (baseline) and during PLR by transthoracic Doppler ultrasound device prior to volume expansion (VE). Measurements were repeated following VE (500ml of 0.9% Normal saline). The change in SV from baseline during PLR was compared with change in VTI and stroke volume (SV) with VE to determine the ability of PLR in conjunction with VTI and SV measurement to predict volume responsiveness.

RESULTS: Out of 118 patients, 65 were responders (change in SV over 15%) and 53 were non-responders. Among the responders, changes in variables like SVI (ml/m2), Systolic ABP (mmHg), Diastolic ABPand Mean ABP were significant (33.4±8.2,40.6±11.4, P=0.007:100.2±16.5 vs 116.6±21.7, P=0.02,:54.5±10.4 vs 66.3±10.7, P=0.005:67.5±11.7 vs 79.9±12.8, P=0.008). Notably the CVP mean, among the responders was statistically significant (6.8±2.8 vs 12.8±3.6, P=0.001). Post PLR, the AUC and the ROC curve of change in SVI and change in CVPmean for predicting the responsiveness after VE were 0.881±0.065 (95% CI 0.759-1.000) and 0.801±0.077 (95%CI 0.650-0.969) respectively. The change in SVI of 8.8% predicted fluid responsivenss with a sensitivity of 72.7% and specificity of 80%; whereas the change in CVP mean of 12.7% predicted fluid responsivess had the same sensitivity and specificity.

CONCLUSIONS: PLR induced changes in VTI and the change in CVPmean are reliable indices for predicting fluid responsiveness in mechanically ventilated patients. Changes in CVPmean is more predictive of preload than other static indicators.

CLINICAL IMPLICATIONS: Use of bedside echocardiography to measure velocity time integral (VTI) to assess for fluid responsiveness is more practical and reliable in mechanically ventilated patients.

DISCLOSURE: The following authors have nothing to disclose: Alai Taggu, Kiran Gudivada, Jerry Thomas, Shashidhar Patil

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