Evaluation of volume response value in patients with septic shock by mechanical ventilation combined with ultrasound / 中华急诊医学杂志

ABSTRACT

Objective:To evaluate the value of mechanical ventilation combined with ultrasound in evaluating the volume reactivity of patients with septic shock.Methods:A prospective study was performed, and 59 patients with septic shock who were admitted to the Emergency Intensive Care Unit of the First Affiliated Hospital of Xinjiang Medical University from October 2016 to February 2018 were included according to the established inclusion and exclusion criteria. First, end-expiratory block test (EEO) and end-inhalation block test (EIO) were performed, followed by volume expansion test (VE) (intravenous infusion of 250 mL saline for 10 min), with cardiac index (CI) change value after VE (&Delta;CI)≥15% for volume-responsive group (37 cases), &Delta;CI<15% for volume-free group (22 cases), Vigileo-FloTrac system was used to continuously monitor EEO, EIO, and VE before and after changes in hemodynamic parameters, such as central venous pressure (CVP), mean arterial pressure (MAP), stroke volume variation (SVV), CI, and improved inferior vena cava diameter (IVCD) and respiratory variability index (RVI). The values of predicted capacity reactivity such as changes in CVP, MAP, SVV, CI, and RVI before and after EIO were evaluated, and the relationship between EEO, EIO, and capacity reactivity was analyzed by ROC curve.Results:There was no significant difference between MAP and CI in the response group and non-response group after EEO, EIO and VE intervention ( P>0.05). EEO-&Delta;SVV, EEO-&Delta;RVI, EEO-&Delta;CVP, EIO-&Delta;SVV and EIO-&Delta;RVI were compared between the reaction group and the non-reaction group, and the difference was statistically significant ( P<0.05); In the correlation analysis, EEO-&Delta;RVI and EIO-&Delta;RVI were correlated with VE-&Delta;RVI ( r=0.695, P<0.01; r=-0.489, P<0.01); EEO-&Delta;CVP and VE-&Delta;CVP were correlated ( r=0.566, P<0.01); EEO-&Delta;SVV, EIO-&Delta;SVV are related to VE-&Delta;SVV ( r=0.842, P<0.01; r= -0.727, P<0.01), and the ROC curve showed ( AUCEEO-&Delta;SVV=0.890, 95% CI 0.792-0.988), showed AUCEEO-&Delta;SVV> AUCEEO-&Delta;RVI> AUCEIO-&Delta;SVV> AUCEIO-&Delta;RVI> AUCEEO-&Delta;CVP. Conclusions:EEO and EIO combined with ultrasound have certain clinical value in the evaluation of volume responsiveness in patients with septic shock, and the evaluation value of SVV and RVI is superior to CVP, MAP, and CI.