Predicting Fluid Responsiveness in Children with Shock

The goal of the study was to assess the sensitivity and specificity of the inferior vena cava (IVC) distensibility index (∆IVC) and respiratory variation in peak aortic blood flow velocity (∆Vpeak) in predicting fluid responsiveness in ventilated children with shock.

This prospective observational study included consecutively enrolled children aged 2 months to 17 years requiring fluid bolus in a pediatric ICU between 2019 and 2020. ∆IVC and ∆Vpeak were measured before and after a 10 ml/kg fluid bolus, and responders were defined as those with a change in stroke volume index (SVI) of ≥10%.

Overall, 37 ventilated children were enrolled, of whom 62% were fluid responsive. The median ∆IVC was higher in responders than the non-responders, and the mean ΔVpeak was also greater in responders. The predictive performance of ∆IVC and ΔVpeak was equivalent, with areas under the ROC curve of 0.73 and 0.78, respectively. The best cut-off values for predicting fluid responsiveness were ∆IVC of 23% (sensitivity 60.8%, specificity 85.7%) and ΔVpeak of 11.3% (sensitivity 74%, specificity 86%).

The findings indicated that both ∆IVC and ΔVpeak were effective predictors of fluid responsiveness in ventilated children with shock.

Source: Banothu KK, Sankar J, Pathak M, Kandasamy D, Gupta P, Kabra SK, Lodha R. Indian Journal of Pediatrics. 2023 Jun 6:1-6.