GEDVI and PPV predict fluid responsiveness in patients with ALI secondary to septic shock / 中华急诊医学杂志

ABSTRACT

Objective To evaluate PICCO (pulse indicator continuous cardiac output) to predict fluid responsiveness in patients with acute lung injury secondary to septic shock.Methods We conducted a prospective study on 42 patients with acute lung injury secondary to septic shock.global end-diastolic volume index (GEDVI),pulse pressure variation (PPV),stroke volume variation (SVV),central vein pressure (CVP) and other haemodynamic data were recorded before and after fluid administration of 500 mL of 6％ hydroxyethyl starch.Responders were defined as patients with an increase in stroke volume index of at least 15％ after fluid loading.Performance of variables was analyzed using receiver operator characteristics analysis.Results GEDVI and PPV,but not SVV and CVP,were able to predict fluid responsiveness in patients with acute lung injury secondary to septic shock 1 hrs after admission to intensive care unit (ICU).The best area under the ROC curve (AUC) was found for GEDVI (AUC 0.802,P ＜0.01) and PPV (AUC 0.752,P ＜0.01) ; the optimal cut-off of GEDVI and PPV were 643.5 mL/m2 and 13.5％,respectively.At this cut point,the sensitivity was 90.9％,the specificity was 91.9％,however,only GEDVI was able to predict fluid responsiveness in patients with acute lung injury secondary to septic shock 6hrs afteradmission to ICU.The best area under the ROC curve (AUC) was found for GEDVI (AUC 0.788,P ＜ 0.01).the GEDVI ＜ 559 mL/m2 during loading were found to predict volume responsiveness with a sensitivity of 100％,specificity of 62.5％.Conclusions GEDVI and PPV predict fluid responsiveness in patients with acute lung injury secondary to septic shock in the early hours.