Predictive value of low volume volume expansion and pulse contour-derived cardiac index on fluid responsiveness in elderly patients with septic shock

Liang Feng-ming; Yang Ting; Yan Jie

doi:10.3969/j.issn.1002-1949.2017.04.007

Abstract：Objective To explore the predictive value of low volume volume expansion(Low-VE)and pulse contour-derived cardiac index(PiCCO)on fluid responsiveness in elderly patients with septic shock. Methods A prospective observational cohort study was conducted. Forty-six elderly pa-tients suffering from septic shock admitted to Department of Intensive Care Unit of our hospital from May 2014 to April 2015 were enrolled. The patients were studied in three phases:before test, Low-VE(100 mL saline infused with 1 minute), and volume expansion(VE)with infusing of 250 mL saline within 10 minutes. Hemodynamic parameters were recorded in every phase. Responders and nonresponders were de-fined by stroke volume(SV)variation after VE. A positive response was defined as a≥15%increase in SV(ΔSVVE≥15%). The receiver operating characteristic(ROC)curve was used to predict the value of hemodynamic parameters before and after Low-VE. Results Of 46 patients, 16 patients were responders, and 30 non-responders. The changes in SV and cardiac output(CO)after Low-VE(ΔSVLow-VE andΔCOLow-VE)were significantly higher in responders than those of non-responders[ΔSVLow-VE:(11.0 ± 3.5)%vs.(4.6 ± 2.7)%, t=6.882 , P=0.000;ΔCOLow-VE:(9.7 ± 4.5)%vs.(4.1 ± 3.2)%, t=4.857, P=0.000], but there was no significant difference in the changes in systolic blood pressure(SBP), mean arterial pressure (MAP), pulse pressure (PP), and heart rate (HR) after Low-VE (ΔSBPLow - VE,ΔMAPLow-VE, ΔPPLow-VE and ΔHRLow-VE)between two groups. The area under ROC curve(AUC)ofΔSVLow-VE≥8.1% for predicting fluid responsiveness was(0.928 ± 0.042, P=0.000), with sensitivity of 81.2% and specificity of 93.3%; the AUC of ΔCOLow-VE≥6.3% for predicting fluid responsiveness was (0.858 ± 0.057, P=0.000), with sensitivity of 87.5%and specificity of 73.3%. Conclusion In elderly patients with septic shock, changes in SV and CO induced by Low-VE are accurate indices for pre-dicting fluid responsiveness, but the changes in SBP, MAP, PP, HR and stroke volume variation(SVV) cannot predict the fluid responsiveness.