Comparison of volume monitoring methods in sepsis patients

Objective: To determine the efficacy, correlation and usability of methods such as central venous pressure (CVP), pulse pressure variation (PPV), inferior vena cava (IVC) index measurement for the evaluation of response to fluid resuscitation in patients with sepsis in the intensive care unit (ICU) . Material and Methods: A total of 36 patients over 18 years of age with mechanical ventilation with sepsis in the ICU were evaluated prospectively. CVP, PPV and IVC diameters (expiratory and inspirium) were measured before fluid replacement. As a fluid replacement, 500 ml of 0.9% NaCl isotonic solution was given intravenously in 30 minutes. and hemodynamic changes were evaluated and recorded intermittently in the 1, 5, 10, 15 and 30th minutes. Ultrasonography revealed with a 2-6 mHz curvlineer probe from subxiphoid window and after determining the diameter of the inferior vena cava in expiration and inspiration, the IVC indexes were calculated. PPV measurement was performed by the monitor with arterial cannulation. Heart rate, systolic and diastolic blood pressure and CVP measurements were also recorded from the patient monitor. The effectiveness and correlation of all these measurements were evaluated. Results: Systolic and diastolic blood pressure, PPV, IVC distensibility index (IVCdi) and CVP measurements were significantly different after short term 500 ml fluid resuscitation. However, there was no correlation between IVC indexes and other measurements. The most frequent changes occurred at the 10th and 15th minutes of the treatment and there was a significant change in CVP, PPV, diastolic blood pressure and IVCdi. Conclusion: Systolic and diastolic blood pressure, PPV, IVCdi and CVP measurements were found to be statistically significant in evaluating the response to fluid resuscitation. Current studies show that dynamic measurements such as PPV and IVC index are superior to others. Due to the widespread use of ultrasonography, we think that IVC measurements would be more preferable because it is a non-invasive and dynamic indicator.