Fig. 4

Volume responsiveness assessment by means of heart–lung interaction-derived indices, in a mechanically ventilated passive patient with septic shock. Septic shock patient with peritonitis caused by colonic perforation. Left-sided panels show a volume responsiveness status, with marked respiratory SVC collapsibility (56%; a, TEE bicaval view, M-mode scanning), IVC distensibility (32%; c, TEE transgastric off-axis view on the IVC, M-mode scanning) and marked LV ejection respiratory variations (36%; e, TEE deep transgastric view, Doppler sampling of LVOT velocities). After 1,500 ml fluid infusion, these respiratory variations are greatly reduced and the various indices show now absence of volume responsiveness (right-sided panels): SVC collapsibility 18% (b), IVC distensibility 5% (d), LV ejection respiratory variations 10% (f). SVC superior vena cava, IVC inferior vena cava, SVCexp SVC diameter at end-expiration, SVCinsp SVC diameter at end-inspiration, IVCinsp IVC diameter at end-inspiration, IVCexp IVC diameter at end-expiration, Vpeak aortic blood flow velocity, VpeakMAX maximum Vpeak velocity, VpeakMIN minimum Vpeak velocity