Document Type
Article
Department
Anaesthesiology (East Africa); Internal Medicine (East Africa)
Abstract
Background: Rapid fluid loading at diagnosis of sepsis is part of standard treatment. Predictive tools of fluid responsiveness are required to guide fluid resuscitation. The Passive Leg Raise [PLR] manoeuvre can predict fluid responsiveness in non-intubated patients with sepsis. The Inferior Vena Cava Collapsibility Index [IVCCI] can also be utilised but is not routinely performed.
Aim: To investigate the correlation between Inferior Vena Cava Collapsibility Index [IVCCI] and a Passive Leg Raise [PLR] manoeuvre for the assessment of fluid responsiveness in non-intubated septic patients in a tertiary referral hospital in Sub-Saharan Africa.
Methodology: A prospective observational study which recruited non-intubated septic patients who were hypotensive [mean arterial pressure less than 65 mm Hg], requiring fluid resuscitation. Focused Cardiac Ultrasound [FoCUS] was used to measure IVCCI followed immediately by a PLR manoeuvre for comparison. Patients were classified as fluid responders if they had an IVCCI ≥ 50% and/or an increase of 10% in pulse pressure following a PLR. The correlation between IVCCI and PLR on each patient in predicting fluid responsiveness was then assessed. Results: 38 patients satisfied the inclusion criteria. McNemar’s test yielded a p=0.039 indicating that PLR test and IVCCI are not equivalent in predicting fluid responsiveness in non-intubated septic patients. A Cohen’s Kappa of 0.283 signified only a “fair” correlation between the two. An IVCCI cut-off of 30% would have resulted in a near- perfect agreement as evidenced by a Cohen’s Kappa value of 0.93. A cut off between 30-40% would give a Cohen’ Kappa of 0.81 with a strong level of agreement.
Conclusion: The PLR test and IVCCI test have a fair correlation and are not identical in predicting fluid responsiveness in non-intubated spontaneously breathing septic patients.
Publication (Name of Journal)
International Journal of Anesthesia and Clinical Medicine
DOI
http://dx.doi.org/10.11648/j.ijacm.20231102.17
Recommended Citation
Githaiga, A.,
Siika, W.,
Mohamed, J.,
Mung’ayi, V.,
Chikophe, I.
(2023). Inferior vena cava collapsibility index versus passive leg raise to assess fluid responsiveness in non-intubated septic patients a prospective observational study. International Journal of Anesthesia and Clinical Medicine, 11(2), 1-10.
Available at:
https://ecommons.aku.edu/eastafrica_fhs_mc_anaesth/48
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