An increase in stroke volume index after an low volume fluid challenge can predict fluid responsiveness in septic shock patients

doi:10.3969/j.issn.1002-1949.2014.12.004

Abstract：Objective To evaluate stroke volume index (SVI) variation after a low volume of fluid infusion(100 mL colloid) as a predictor of fluid responsiveness in mechanically ventilated patients with septic shock .Methods A prospective observation of 23 fluid challenges during fluid resuscitation for treatment of hemodynamic instability was preformed .Hemodynamic parameters were measured by pulse indicator continuous cardiac output (PiCCO) system before fluid infusion (baseline), after 100 mL colloid infusion and after an additional infusion of 400 mL fluid.Fluid responsiveness was defined as the changes in SVI increase ≥10%after 500 mL colloid loading .Receiver operating characteristic curves were generated for variation of SVI after 100 mL fluid infusion (△SVI100 ).Comparison of fluid responsiveness predictive value of 100 mL and 500 mL fluid challenge was performed .Results Among the 23 septic shock patients , 11 were found responsive to fluid loading , 12 were not .The results demonstrated that △MAP, △SVI500 and △SVI100 of the responsive group were higher than those of nonresponsive group . The areas under the receiver operating characteristic curve ( ROC curve ) for△SVI100 was 0.811(95%CI 0.617~1.005, P=0.012).Using △SVI100≥9.5% as the threshold to predict fluid responsiveness , the sensitivity was 81.8%and specificity was 83.3%.The predictive ability of fluid responsiveness of 100 mL colloid loading was similar to 500 mL fluid challenge (P=1.00). Conclusion The low volume of fluid infusion can predict fluid responsiveness in mechanically ventilated patients with septic shock , and guide fluid therapy .