E. ABAHUJE1, R. RIVIELLO2, F. NTIRENGANYA1 1National University Of Rwanda,SURGERY,Butare, , Rwanda 2Brigham And Women’s Hospital,Boston, MA, USA
Introduction:
Management of patients with severe sepsis and septic shock due to intra-abdominal infection includes resuscitation with intravenous fluids, anti-microbial therapy and timely control of the source of infection. These patients need to achieve adequate hemodynamic status before being taken to the operating room. Several parameters (urinary output, vital signs, inferior vena cava collapsibility index, and central venous pressure) are being used to assess hemodynamic response to fluids resuscitation, but the options are still few in limited resource settings. This study aimed at assessing if a bedside performed ultrasound to assess the inferior vena cava collapsibility index is superior to urinary output in assessing hemodynamic response to fluid resuscitation.
Methods:
This study was carried out on patients of 18 years and above who presented with intra-abdominal infection and who needed intravenous fluid resuscitation prior to being taken to the operating room. At admission, before intravenous fluids (IVF) administration, the baseline inferior vena cava collapsibility index (IVC-CI) and vital parameters were recorded. After initiation of resuscitation with IVF, serial measurement of IVC-CI and urinary output were recorded every two hours until the decision was made to take the patient to the operating room.
Results:
24 patients were enrolled, 79.2% were male . Time from onset of the symptoms to time of admission to our hospital ranged from 1 to 21 days with a mean duration of symptoms of 4.7 days. 4 patients (16%) had altered mental status as a result of septic shock.
50% off all the patients had generalized peritonitis due to gangrenous bowel as the clinical diagnosis.
The mean of difference between time of hemodynamic response based on IVC-CI versus urinary output was 2 hours. Mean time from admission to time of fluid response based on inferior vena cava collapsibility index was 0.708 (0.39-1.03) while the mean time from admission to time of hemodynamic response based on urinary output was 2.708 (1.85-3.57) with a p-value less than 0.05 (0.000)
Conclusion:
This study suggests that measurement of the inferior vena cava collapsibility index can provide early detection of hemodynamic response to fluid therapy in patients with intra-abdominal infection with spontaneous breathing compared to urinary output.