The predictive value of cardiopulmonary interaction monitoring technology on volume responsiveness in septic shock patients / 中华急诊医学杂志

ABSTRACT

Objective To assess the predictive value of cardiopulmonary interaction monitoring technology on volume responsiveness in septic shock patients.Methods A cohort of 45 septic shock patients treated with mechanical ventilation at First People's Hospital of Nantong City from January 2016 to June 2017 were prospectively selected.The hemodynamic variables including heart rate (HR),systolic pressure (SBP),mean arterial pressure (MAP),central venous pressure (CVP),cardiac index (CI),stroke volume variability (SVV),and pulse pressure variability (PPV) were monitored.PEEP elevation test,end-expiratory occlusion test and volume expansion were sequential conducted.Volume responsiveness was defined as an increase in CI (△CI) of 15％ or greater after volume expansion,namely the response group (△CI ≥ 15％) and non-response group (△CI＜15％).Receiver operating characteristic (ROC) curve was constructed to indicate the predictive value of cardiopulmonary interaction monitoring technology in septic shock patients.The best cut-off value was assessed by Youden Index,and sensitivity and specificity were calculated respectively.Results There were 24 patients in the response group and 21 patients in the non-response group.There were no significant differences in basic clinical data between the two groups.△fter PEEP elevation test,CVP increased significantly,while SBP and CI decreased significantly in both groups (P＜0.05).The degrees of △SBP and △CI in the response group were much higher than those in the non-response group (P＜0.05).After end-expiratory occlusion test,CVP decreased significantly,while SBP,MAP and CI increased significantly in both groups (P＜0.05).The degrees of △MAP and △CI in the response group were much higher than those in the non-response group (P＜0.05).SVV and PPV in the response group were higher than those in the non-response group (P＜0.05).The area under the ROC curve (AUC) of the △SBP and △CI after PEEP elevation test and △MAP and △CI after end-expiratory occlusion test were 0.737 (95％CI0.581-0.89;P＜0.05),0.803 (95％CI0.660-0.946;P＜0.05),0.763 (95％CI0.617-0.908;P＜0.05),and 0.808 (95％CI0.673-0.942;P＜0.05),respectively.These AUC values were higher than or similar to traditional indicators,such as SVV and PPV.The best cut-off value of △CI and △SBP after PEEP elevation test was 12％ and 9.5％,yielding a sensitivity and specificity of 70.8％and 95.2％,75％ and 71.4％,respectively.The best cut-off value of △CI and △MAP after end-expiratory occlusion test was 8.5％ and 5.5％,yielding a sensitivity and specificity of 79.2％ and 76.2％,75％ and 76.2％ respectively.Conclusion △SBP and △CI after PEEP elevation test and △MAP and △CI after endexpiratory occlusion test can accurately predict volume responsiveness in septic shock patients.