Predicting Fluid Responsiveness Using Bedside Ultrasound Measurements of the Inferior Vena Cava and Physician Gestalt in the Emergency Department of an Urban Public Hospital in Sub-Saharan Africa

• Published in: PloS one 2016-09, Vol.11 (9), p.e0162772-e0162772
• Main Authors: Sawe, Hendry Robert, Haeffele, Cathryn, Mfinanga, Juma A, Mwafongo, Victor G, Reynolds, Teri A
• Format: Article
• Language: English
• Subjects: Blood; Blood pressure; Comparative analysis; Dehydration; Emergency medical care; Emergency medical services; Emergency services; Family physicians; Fluid; Fluids; Hemorrhage; Hospital emergency services; Hospitals; Hypotension; Intravenous administration; Measurement; Medical referrals; Medical research; Medicine; Medicine and Health Sciences; Mortality; Patients; People and Places; Research and Analysis Methods; Resuscitation; Sensitivity; Sepsis; Systematic review; Ultrasonic imaging; Ultrasound
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0162772

Bedside inferior vena cava (IVC) ultrasound has been proposed as a non-invasive measure of volume status. We compared ultrasound measurements of the caval index (CI) and physician gestalt to predict blood pressure response in patients requiring intravenous fluid resuscitation. This was a prospective study of adult emergency department patients requiring fluid resuscitation. A structured data sheet was used to record serial vital signs and the treating clinician's impression of patient volume status and cause of hypotension. Bedside ultrasound CI measurements were performed at baseline and after each 500mL of fluid. Receiver operating characteristic (ROC) curve analysis was performed to characterize the relationship between CI and Physician gestalt, and the change in mean arterial pressure (MAP). We enrolled 364 patients, 52% male, mean age 36 years. Indications for fluid resuscitation were haemorrhage (54%), dehydration (30%), and sepsis (17%). Receiver operating characteristic curve analysis found optimal CI cut-off values of 45%, 52% and 53% to predict a MAP rise of 5, 8 and 10 mmHg per litre of fluid, respectively. The sensitivity and specificity of CI of 50% for predicting a 10mmHg increase in MAP per litre were 88% (95%CI 81-93%) and 73% (95%CI 67-79%), respectively, area under the curve (AUC) = 0.85 (0.81-0.89). The sensitivity and specificity of physician gestalt estimate of volume depletion severity were 68% (95%CI 60-75%) and 86% (95%CI 80-90%), respectively, AUC = 0.83 (95% CI: 0.79-0.87). Those with a baseline CI ≥ 50% (51% of patients) had a 2.8-fold greater fluid responsiveness than those with a baseline CI