Objective:

To analyze the performance of mitral E/e’ measured by transthoracic echocardiography in predicting fluid responsiveness in shock patients and compare it with the inferior vena cava variability index (IVCVI).

Approach:

• Study Design: Analyzed data from adult, mechanically ventilated patients with shock in the medical ICU at Siriraj Hospital, Bangkok, Thailand, between October 2021 and September 2024.
• Echocardiographic Measurements: Performed transthoracic echocardiography to obtain hemodynamic parameters, including mitral E/e’ and IVCVI.
• Fluid Challenge: Administered 300 mL of acetate Ringer’s solution over 15 minutes and reassessed parameters to evaluate fluid responsiveness.

Key Findings:

• IVCVI demonstrated the highest discrimination for fluid responsiveness with an AUROC of 0.788 (95%CI 0.671–0.905; P < 0.001).
• Mitral E/e’ had an AUROC of 0.682 (95%CI 0.535–0.826; P = 0.026).
• Optimal cutoffs were > 18% for IVCVI and < 10 for mitral E/e’.
• Fluid responsiveness was defined as an increase in cardiac index > 15% or MAP increase > 5 mmHg.

Interpretation:

Limitations:

• Study included only mechanically ventilated shock patients.
• Results may not be generalizable to non-ventilated patients or those with different types of shock.

Conclusion: