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CRITICAL CARE AND TRAUMA

The Intrathoracic Blood Volume Index as an Indicator of Fluid Responsiveness in Critically Ill Patients with Acute Circulatory Failure: A Comparison with Central Venous Pressure

Laurent Muller, MD, MSc^*, Guillaume Louart, MD^*, Christian Bengler, MD^*, Pascale Fabbro-Peray, MD, Julie Carr, MD^*, Jacques Ripart, MD, PhD^*, Jean-Emmanuel de La Coussaye, PhD, MD^*, and Jean-Yves Lefrant, MD, PhD^*

From the *Division Anesthésie Réanimation Douleur Urgences, Groupe Hospitalo-Universitaire Caremeau, CHU Nîmes, Place du Professeur Robert Debré, 30 029 Nîmes Cedex 9. Faculté de Médecine, Université Montpellier 1; Equipe d’Accueil 2992, Laboratoire de physiologie cardiovasculaire et d’anesthésie expérimentale, Faculté de Médecine, Groupe Hospitalo-Universitaire Caremeau, Place du Professeur Robert Debré, 30 029 Nîmes; and Département d’Information médicale, Groupe Hospitalo-Universitaire Caremeau, CHU Nîmes, Place du Professeur Robert Debré, 30 029 Nîmes Cedex 9. Faculté de Médecine, Université Montpellier 1.

BACKGROUND: The intrathoracic blood volume index (ITBVI) and central venous pressure (CVP) are routinely used to predict fluid responsiveness in critically ill patients with acute circulatory failure (systolic blood pressure <90 mm Hg or vasopressor requirement). However, they have never been compared.

METHODS: In this prospective interventional study, we included 35 (21 men) mechanically ventilated and sedated patients with acute cardiovascular failure requiring cardiac output measurement (transpulmonary thermodilution technique). Fluid responsiveness was defined as an increase in stroke index (cardiac output/heart rate/body surface area) 15%. Receiver operating characteristic curves were generated for ITBVI and CVP.

RESULTS: Fluid challenge induced a stroke index increase 15% in 18 (51%) patients (responders). At baseline, no studied hemodynamic variables were different between responders and nonresponders. The areas under the receiver operating characteristic curves were 0.64 [95% CI: 0.46–0.80] for ITBVI and 0.68 [95% CI: 0.50–0.83] for CVP, without any statistical difference (P = 0.73). The best cut-off values for CVP and ITBVI were 9 mm Hg (sensitivity = 61%; specificity = 82%) and 928 mL · m^–2 (sensitivity = 78%; specificity = 53%).

CONCLUSION: ITBVI is similar to CVP in its ability to predict fluid responsiveness in critically ill patients with acute circulatory failure.