Comparing the non-invasive cardiometry with ultrasound-guided inferior vena cava collapsibility for evaluation of fluid responsiveness in septic patient: a randomized clinical trial

Abstract

Background
Improving tissue perfusion is fundamental for management of septic patients. Various invasive and non-invasive hemodynamic monitoring tools are used to guide fluid therapy properly and identify the early need for vasopressors or inotropes. This study intended to compare Electrical cardiometry (EC) versus Ultrasound-guided IVC collapsibility index (IVC-CI) for non-invasive bedside assessment of fluid responsiveness in patients with sepsis.


Methods
Sixty patients, aged 18–70 years, admitted to intensive care unit (ICU) with sepsis (SOFA score ≥ 2) were randomly allocated in two groups; group A in which EC monitor was used to assess fluid response (SVV > 15% as responder) and group B in which IVC ultrasonography was applied to assess fluid response (IVC-CI > 50% as responder). The 30-day mortality rate was recorded as primary outcome. Meanwhile, total amount of fluids, dose and duration of vasopressors, incidence of mechanical ventilation, ICU and hospital stay periods were recorded as secondary outcomes.


Results
No significant differences were noted regarding mortality incidence, ICU stay, and hospital stay periods. EC group demonstrated higher norepinephrine utilization (21.92 ± 16.37 vs 9.93 ± 9.57; p = 0.001), longer time to wean the vasopressors, and lower fluid consumption (3431.67 ± 1034.78 vs 4216.67 ± 1199.38; p = 0.009) than IVC group over 24 h. Fluid responders in each group showed higher values of SVV and IVC-CI than non-responders with comparable values regarding the conventional hemodynamic and clinical indices.


Conclusion
Both cardiometry and IVC-ultrasound can be applied equally to guide fluid therapy in sepsis. However, cardiometry use was associated with higher vasopressors utilization and less fluid infusion over 24 h of observation.