The prediction of fluid responsiveness by end-expiratory occlusion test in mechanically ventilated patients with septic shock: a bicentric study

Background Prediction of fluid-responsiveness is of utmost importance in the management of patients with septic shock. Echocardiography is a bedside, feasible tool in the assessment of fluid-responsiveness. End expiratory occlusion (EEO) test can be utilized in the prediction of fluid responsiveness in mechanically ventilated, sedated, and paralyzed patients with septic shock. Our study aimed to investigate whether changes in velocity time integral (VTI) and peak velocity and hence, Cardiac Output during an EEO test could predict fluid responsiveness in mechanically ventilated Intensive care unit patients with septic shock. Methods We studied 60 patients with septic shock, mechanically ventilated, sedated, and paralyzed admitted from October 2023 to March 2024 in the Critical Care Medicine departments in Cairo and Mansoura Universities. Complete medical history, physical examination, and laboratory investigations were obtained on admission. All hemodynamic and echocardiographic parameters were assessed at baseline, after the EEO test, and after 500 cc crystalloid fluid administration. Results The mean age in the study population was 63±10.67 years, among fluid responders, a 15 s EEO test showed a statistically significant increase in mean peak velocity, VTI, stroke volume, and CO with a P value less than 0.001. EEO induced an increase in VTI cutoff point of differentiation of fluid-responsiveness prediction was 15.04% with a sensitivity of 76% and specificity of 90%. EEO induced an increase in CO cutoff point of differentiation of fluid-responsiveness prediction was 14.79% with a sensitivity of 66% and specificity of 90%. Conclusion Using Bedside transthoracic echocardiography EEO test is a feasible, sensitive, and highly specific method for the prediction of fluid-responsiveness in mechanically ventilated patients with septic shock.