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Objective:To evaluate the value of bedside ultrasound in evaluating volume responsiveness of patients with septic shock.Methods:A total of 102 patients with septic shock admitted to ICU of the First Affiliated Hospital of Hebei North University from April 2018 to February 2021 were selected. Patients were divided into response group and non-response group according to the value of stroke volume increase (ΔSV) after volume loading test (VE), and the hemodynamic parameters before and after VE were compared between the two groups. Pearson correlation was used to analyze the relationship between ΔSV and hemodynamic indexes. Receiver operating characteristic (ROC) curve was drawn to analyze the sensitivity and specificity of each hemodynamic index in evaluating volumetric reactivity in patients with septic shock.Results:Of the 102 patients, 54 responded and 48 did not. Before VE, the distensibility index of inferior vena cava (ΔIVC 1), espiratory variability index of inferior vena cava (ΔIVC 2), respiratory variability of aortic peak velocity (ΔVpeak AO), brachial artery maximum velocity variability (ΔVpeak BA) and respiratory rate of peak flow velocity of femoral artery (ΔVpeak CFA) in response group were higher than those in non-response group (all P<0.05), but there was no statistical significance in heart rate (HR), mean arterial pressure (MAP) and central venous pressure (CVP) between 2 groups (all P>0.05). After VE, the HR, ΔIVC 1, ΔIVC 2, ΔVpeak AO, ΔVpeak BA and ΔVpeak CFA in response group were significantly decreased, while MAP and CVP were significantly increased (all P<0.05). The CVP was significantly decreased in the non-response group ( P<0.05), while other indexes were not significantly changed. Before VE, the ΔIVC 1, ΔIVC 2, ΔVpeak AO, ΔVpeak BA and ΔVpeak CFA were positively correlated with ΔSV ( r=0.589, 0.647, 0.697, 0.621, 0.766; all P<0.05). There was no correlation between CVP and ΔSV ( r=-0.345, P>0.05). Before VE, the area under the curve of ΔIVC 1, ΔIVC 2, ΔVpeak AO, ΔVpeak BA and ΔVpeak CFA were all >0.7, indicating high sensitivity and specificity. Conclusions:Bedside ultrasound monitoring ΔIVC, ΔVpeak AO, ΔVpeak BA and ΔVpeak CFA can better evaluate the volume response of patients with septic shock, and can provide a reference basis for clinical fluid resuscitation treatment.
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Cardiovascular disease is the main cause of death in patients with diabetes. Cardiovascular disease and risk management in patients with diabetes has always been a hot topic in the field of diabetes. At the 56th Annual Meeting of the European Association for the Study of Diabetes (EASD), Professor Naveed Sattar, recipient of the Camillo Golgi Prize and from the University of Glasgow, UK, expounded the role of volume overload and ectopic fat in cardiovascular risk of patients with type 2 diabetes, which brought new enlightenment for future research and comprehensive management.
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ObjectiveThe assessment of volume load status in patients with acute heart failure is of great significance for preventing volume overload. The aim of this study was to explore the predictive value of NT-proBNP level and IVC-CI on volume load and prognosis in patients with acute heart failure. MethodsFrom January 2017 to April 2019, the clinical characteristics of 98 patients with acute heart failure diagnosed and treated in the Peking University People's Hospital were retrospectively reviewed in this study. All of them were treated with routine anti-heart failure treatment. According to the level of relative volume balance, they were divided into volume overload group (65 cases) and non-volume overload group (33 cases). All the patients were followed up for 30 days after discharge. The patients with death and cardiogenic rehospitalization were included in the event group (30 cases), and the rest were in the non-event group (68 cases). NT-proBNP and IVC-CI in different volume load groups and different prognosis groups were compared. The volume index levels (serum albumin, hemoglobin, hematocrit, PCWP, CVP) of patients in different volume load groups were compared. The effects of NT-proBNP and IVC-CI on volume load and prognosis of patients were analyzed.ResultsThe levels of NT-proBNP [（1306.39±313.98）pg/mL], PCWP [（19.63±1.95）mmHg] and CVP [（14.65±1.03）cmHg] in the volume overload group were higher than those in the non-volume overload group, while the IVC-CI [（38.26±8.14）%], albumin [（16.23±2.12）g/L], hemoglobin and hematocrit [（36.26±2.78）%] in the volume overload group were lower than those in the non-volume overload group (P0.05). On discharge, the AUC of NT-proBNP, IVC-CI in predicting patients with acute heart failure was respectively 0.806 and 0.847. Although the prediction accuracy was relatively high, the AUC of combined prediction was 0.982, which was significantly higher than that of NT-proBNP and IVC-CI (Z=3.589, 3.274, both P<0.05).Conclusion There is a correlation between NT-proBNP, IVC-CI and volume indexes. The combined detection of NT-proBNP and IVC-CI can help to assess the volume load status of patients with acute heart failure and improve the predictive value of short-term prognosis of patients.
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Objective: Approximately 50% of end stage renal disease (ESRD) patients lose their lives as a consequence of cardiovascular diseases due to accelerated atherosclerosis. The objectives of this study were to investigate the synergistic effect between nutritional status, inflammation and volume load with atherogenesis estimated using structural and hemodynamic changes in the carotid arteries (CA) in patients on peritoneal dialysis (PD). Methods: Prospective longitudinal study. The study sample consisted of 50 ESRD patients who were treated with PD and were observed for an 18 months after the commencement of dialysis treatment. All examined patients underwent 4 to 5 dialysis changes with 2 liters of dialysis solution. The laboratory findings were complemented with ultrasound of CA and echocardiography at baseline and at the end of follow-up. Results: C-reactive protein (CRP), B-type natriuretic peptide and homocysteine significantly were significantly decreased, while normal protein nitrogen appearance (nPNA) and albumin values were significantly increased after 18 months on PD. The carotid intima-media thickness (CIMT), left atrium diameter was significantly decreased (p<0.001) at the end of the study. Significant predictors of CIMT and CA diameter were residual renal function (RRF), albumin and CRP whereas significant predictors of presence of atherosclerotic plaques were RRF and CRP. Conclusion: We have found a close relationship between hemodynamic and structural CA changes with markers of poor nutrition, inflammation and hydration status in PD patients. The synergism of atherogenesis and monitored parameters, especially CA diameter and CIMT, seems to be useful in the management of PD patients and deserves further testing in properly designed clinical validation study.
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Acute kidney injury(AKI) is a clinical critical syndrome caused by a variety reason,sepsis is the leading cause and independently associated with mortality in critical patients.Fluid resuscitation is one of the most important treatment of spesis and AKI.Fluid overload has been shown to be associated with worse outcomes in critically ill patients.Different liquid treatment should be adopted in different stages.To carry out dynamic,noninvasive hemodynamic monitoring is the best way to critical patients with AKI liquid management.
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Objective To discuss the major cardiovascular disease(CVD) risk factors and volume load of women.Methods A cross-sectional study was conducted on adult women who came to our hospital for health examination.The clinical data included age, past medical history, smoking history, drinking history, body measurements (height, body weight, blood pressure, etc.), and blood serum creatinine, hemoglobin, blood glucose, blood lipid and other biochemical indicators were detected.Using the human body composition analyzer, the extracellular fluid (ECW), intracellular fluid (ICW), total water(TBW), and ECW/TBW ratio (E/T) were used to evaluate the capacity of the cells.Total body water(TBWwatson) was Calculated according to Watson formula.The clustering of four major CVD risk factors (defined as two or more of the following: hypertension, diabetes, dyslipidemia and overweight) and their association with volume load were investigated.Volume load was evaluated by bioelectrical impedance analysis.Hypovolaemia was defined as extracellular water/total body water (ECW/TBW) at and under the 10 percentile for the normal population.Logistic regression model was use to explore the relationship between capacity status and risk factors of CVD.Results A total of 2 433 women (mean age (37.4±7.3) years old) were enrolled in the study, 14.7％ of them had clustering of CVD risk factors.Hypovolaemia in clustering group was statistically higher than either in the single or in the none risk factor group, which was 18.2％, 11.9％, 6.7％, respectively (x2 =45.4, P＜0.001).After adjusted for potential confounders (including age, hemoglobin, serum uric acid, estimating glomerular filtration rate (eGFR), hypovolaemia was associated with clustering of CVD risk factors, with an OR of 2.76 (95％ CI 1.93-3.95).Conclusion Hypovolaemia is associated with clustering of major CVD risk factors in women, which further confirms the importance of modifying lifestyle to reduce the burden of CVD.