The Correlation Of Inferior Vena Cava Diameter Measured By Ultrasonography And It's Respiratory Variation Index With Centre Venous Pressure In Patients With Sepsis

Objectives:CVP has been recommended for guiding fluid resuscitation in sepsis,but recently studies suggested that CVP can't reflect volume state,while the diameter of inferior vena cava and its' respiratory variation index are the proper indices for volume status and fluid responsiveness.The purposes of this article are to explore whether there is a correlation between inferior vena cava(IVC)diameters measured by bedside ultrasonography,its' respiratory variability index and central venous pressure,and to prove the application values of IVC diameters,IVC-RVI,and CVP in guiding fluid resuscitation in patients with sepsis.Methods:A prospective,single-center and observational study was done at emergency department(ED)and emergency intensive care unit(EICU)of the first affiliated hospital of Kunming medical university,sixty-four subjects presenting sepsis from March 2017 to March 2018 were enrolled(in which 51.6%with mechanical ventilation),central line was placed at enrollment,and an initial fluid resuscitation of 30ml/kg was given to these patients at the same time,IVC diameters,IVC-RVI,CVP and relevant clinical data were collected at admission(Omin),30min,1h and 3h.Results:Sixty-four patients were included in this study,they were divided into two groups:mechanical ventilation group(Group A,N=33)and spontaneous respiratory group(Group B,N=31).Mean CVP was 6.68 ± 1.86cm of H2O,and respectively mean maximum and minimum IVC diameters of 14.50 ± 2.61mm,11.03±3.17mm,IVC-RVI of(24.12 ± 13.40)%were observed at admission in Group A.CVP and IVC diameters showed a serial improvement with fluid resuscitation(P<0.050),the IVC-RVI dropped to(17.12±9.02)%,but the decline of IVC-RVI was not statistically significant(P= 0.134);heart rate(HR),mean blood pressure(MAP),respiratory rate and level of lactate also showed serial improvements with treatment(P<0.05).In Group B,we observed a mean CVP value of 6.34 ± 0.80cm of H2O,mean maximum and minimum IVC diameters of 13.87 ± 1.16mm and 7.83 ±1.22mm,IVC-RVI was(43.60 ± 6.86)%at admission.CVP and IVC diameters sharply increased,and IVC-RVI decreased during the fluid resuscitation(P<0.050);there also showed marked declines in heart rate,respiratory rate and the level of lactate(P<0.050),mean blood pressure raised obviously(P<0.001).CVP showed a positive correlation with IVC diameters both in Group A and Group B,a negative correlation with IVC-RVI in Group B,and no significant correlation in subjects with mechanical ventilation.Conclusions:1.Effective fluid resuscitation can improve CPV,IVC diameters and decrease IVC-RVI in patients with sepsis.2.In mechanical ventilation group,CVP has a positive correlation with IVC diameters,but doesn't show correlativity with IVC-RVI.3.In patients with spontaneous respiratory,a positive correlation with CVP and IVC diameters and a negative correlation with IVC-RVI are observed.4.In the early stage of sepsis fluid resuscitation,the IVC diameter and CVP can reflect the volume status in patients with mechanical ventilation,and guide the fluid resuscitation.While in patients with spontaneous respiration,the CVP,IVC diameters and the IVC-RVI can reflect the volume state and guide fluid resuscitation.