Assessment of hemodynamic response to fluid resuscitation of patients with intra-abdominal sepsis in low- and middle-income countries.

BACKGROUND: Patients with intra-abdominal infections need to achieve adequate hemodynamic status before being taken to the operating room. Multiple parameters (urinary output [UOP], vital signs, inferior vena cava collapsibility index, and central venous pressure) may be used to assess hemodynamic response to fluid resuscitation, but the options are 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 UOP in assessing hemodynamic response to fluid resuscitation.

METHODS: All adult patients presenting to a tertiary referral hospital in the capital city of Rwanda with intra-abdominal infection requiring intravenous fluid (IVF) resuscitation before operation were included in this study. Before IVF administration, the baseline inferior vena cava collapsibility index (IVC-CI) and vital parameters were recorded. After initiation of IVF resuscitation, serial measurements of IVC-CI and UOP were recorded every 2 h until the decision was made to take the patient to the operating room.

RESULTS: Twenty-four patients were enrolled. The mean duration of symptoms was 4.7 days. Four patients (16%) had altered mental status as a presenting symptom. Half of all patients had generalized peritonitis due to gangrenous bowel as the primary diagnosis (n = 12). The mean difference between time of hemodynamic response based on IVC-CI versus UOP was 2 h (P < 0.001).

CONCLUSIONS: Measurement of the IVC-CI can provide early detection of hemodynamic response to fluid therapy in patients with intra-abdominal infection with spontaneous breathing compared to UOP. Future research should utilize this parameter in the preoperative management of hemodynamically unstable patients.