Study on the clinical value of bedside ultrasound in evaluating the fluid responsiveness in patients with septic shock / 天津医药

ABSTRACT

Objective To study the clinical value of bedside ultrasound in predicting the fluid responsiveness in pa?tients with septic shock in intensive care unit (ICU). Methods Forty-two mechanically ventilated patients with septic shock who admitted to ICU of the Affiliated Hospital of North China University of Science and Technology from January 2015 to April 2015 were included in this study. All patients were treated with volume expansion (VE) text. Hemodynamics in?dexes were obtained by ultrasound before and after each test, including stroke volume (SV), aortic peak blood flow velocity variation rate of breathing (△VpeakAO), inferior vena cava expansion index (△IVC) and brachial artery maximum speed vari?ation rate (△VpeakBA). Clinical data and central venous pressure (CVP) were recorded. Based on the responsiveness of SV, patients were divided into responsive group (R) and non-responsive group (NR), respectively. The differences of the above in?dexes were compared between two groups. The correlation of△IVC,△VpeakAO,△VpeakBA and△SV was determined. The role of the hemodynamic index for predicting volume responsiveness was evaluated by receiver operating characteristic ROC curves. Results A total of 47 VE tests were performed in 42 patients, 25 in R group and 22 in NR group. Before VE test, the hemodynamics indicators of△IVC,△VpeakAO and△VpeakBA were significantly higher in R group compared with those of NR group (P<0.05). The values of△IVC,△VpeakAO and△VpeakBA were positively correlated with△SV in two groups. The areas under the ROC curve of the hemodynamics indicators were 0.825, 0.853 and 0.866 for △IVC, △VpeakAO and△VpeakBA, and they all showed high sensitivity and specificity. Conclusion The hemodynamic index measured by bedside ultrasound can predict the volume responsiveness in mechanically ventilated patients with septic shock fluid therapy, and which can be used to fluid therapy with a high degree of specific and sensitivity in clinical practice.