The role of internal jugular vein and inferior vena cava distensibility indices as parameters of fluid responsiveness in mechanically ventilated septic shock patients

Context The use of dynamic parameters for the assessment of fluid responsiveness in septic shock patients has increased in recent years. Aims In this study, we examined the ability of internal jugular vein distensibility index (ΔDIJV) and inferior vena cava distensibility index (ΔDIVC) to predict volume responsiveness in the management of mechanically ventilated septic shock patients. Settings and design Prospective interventional cohort study. Patients and methods This study enrolled 34 septic shock patients. Hemodynamic data coupled with echocardiographic assessment of cardiac index (ΔCI), ΔDIVC, and ΔDIJV were assessed before and after 7 ml/kg fluid challenge. Patients were considered as fluid responders if a rise in ΔCI more than or equal to 15% took place after volume expansion, and if ΔCI was less than 15%, the patients were considered nonresponders. Results The area under the curve of ΔDIVC was 0.940 with the best cut off value of less than or equal to 13.6% with sensitivity, specificity, positive predictive value, and negative predictive value of 94.74, 80.00, 85.7, and 92.3%, respectively. While the area under the curve for ΔDIJV was 0.900 with the best cutoff value of less than or equal to 11.6% with sensitivity, specificity, positive predictive value, and negative predictive value of 84.21, 80.00, 84.2, and 80.0%, respectively. Conclusions Ultrasonic evaluation of respirophasic changes of internal jugular vein is a simple, easy, and readily accessible bedside measure of fluid responsiveness in mechanically ventilated, sedated septic shock patients. ΔDIJV can predict fluid responsiveness with good sensitivity, specificity, and overall accuracy. Meanwhile, ΔDIVC is still more sensitive with better overall accuracy.