Treatment Fluid Volume May Predict Stroke Volume Improvement

INTRODUCTION: Cardiac function is known to be negatively impacted by sepsis. Monitoring Cardiac Output (CO) and Stroke Volume (SV) trends over the course of treatment may provide insight into cardiac function and may be used to predict patient outcome. In the FRESH study, we have previously shown the impact of the volume of administered treatment fluid on fluid balance and patient outcome. The goal of this study was to explore the relationship between volume of fluid and stroke volume improvement in septic patients. METHOD(S): The Starling Registry study is an observational registry study evaluating trends in CO and SV over time as related to patient outcome (NCT04648293). Patients that exhibited an overall improvement in SV (first SV measurement compared to last SV measurement) were compared to those who did not exhibit improvement. RESULT(S): A total of 201 patients received hemodynamic monitoring during their stay at three different ICUs. 46% were female, and the average age was 63 years. 72% of the patients had sepsis, and 20% of patients were positive for COVID. When patients who improved their stroke volume over the course of treatment were compared to those who did not improve, results indicate that SV improved patients had received a total volume fluid of 1241 ml, while patients did not improve received 893 ml fluid, for a difference of 348 ml (p=0.018). CONCLUSION(S): Registry patients with minimal change in stroke volume appear to receive less fluid volume. FRESH and other studies have shown improved outcomes in restricting fluid in non-preload dependent (non-fluid responsive) state. Further research in the phenotype of nonresponsive patients may be helpful in identifying new methods to improve outcomes in this group.

Stroke Volume Change May Predict Outcome in Patients with Lv/Rv Dysfunction

INTRODUCTION: Cardiac function is known to be negatively impacted by sepsis. Monitoring Cardiac Output (CO) and Stroke volume (SV) trends over the course of treatment may provide insight into cardiac function and may be used to predict patient outcome. In the FRESH study, we have previously shown that patients who improve CO and SV exhibit improved outcome such as decreased mortality and decreased need for ventilation. The goal of this study was to explore the relationship between the change in stroke volume and cardiac output in patients with LV and RV Dysfunction. METHOD(S): The Starling Registry study is an observational registry study evaluating trends in CO and SV over time as related to patient outcome (NCT04648293). Patients that exhibited an overall improvement in CO (first CO measurement compared to last CO measurement) were compared to those who did not exhibit improvement. RESULT(S): 71 patients with LV/RV dysfunction received hemodynamic monitoring during their stay across 4 units at 3 hospitals. 48% were female, and the average age was 68 years. 67% of the patients had sepsis, and 17% of patients were positive for COVID. Notably, in this population of LV/ RV dysfunction, patients with COVID (p=0.016), pneumonia (p=0.034) and those that required oxygen treatment (p=0.034) were less likely to improve Cardiac Output following fluid challenge. CONCLUSION(S): Patients with LV/RV dysfunction represent a vulnerable population. We have previously shown the benefits of trending cardiac output and stroke volume in this patient population (ATS, 2018). Trends observed in this population may help indicate which patients may be at risk for more negative outcome.

FLUID RESPONSIVENESS AND PATIENT OUTCOMES

SESSION TITLE: Sepsis: Beyond 30cc/kg and Antibiotics SESSION TYPE: Rapid Fire Original Inv PRESENTED ON: 10/19/2022 11:15 am - 12:15 pm PURPOSE: Cardiac function is known to be negatively impacted by sepsis. Stroke volume (SV) change in response to Passive Leg Raise (PLR) is an effective method to predict fluid responsiveness (FR) or cardiac response to preload expansion. We have previously shown that short-term sepsis resuscitation phenotypes based responses to passive leg raise (PLR) can identify discrete patient sub-groups. The goal of this study was to identify resuscitation phenotypes and explore the relationship between the cardiac physiology and patient outcome. METHODS: The Starling Registry study is an observational registry study evaluating trends in cardiac output (CO) and SV over time as related to patient outcome (NCT04648293). Patients were classified as FR if SV increased ≥ 10% when measured with non-invasive bioreactance (Starling Monitor, Baxter Healthcare). Patients were characterized Non FR if SV increased <10%. Patients were grouped into 6 different sextets based on the percentage of FR PLRs within each group. RESULTS: 222 critical care patients received hemodynamic monitoring during their ICU stay across two different hospitals. 46 % were female, and the average age was 64 years. 65% of the patients had sepsis, and 20% of patients were positive for COVID. There were an equal percentage of septic patient in whose who were not FR (68%) and patients who were 100% FR (65%, p=0.334). Patients who were not FR received significantly less resuscitation fluid (609 ml) compared to patients who were 100% FR (1094 ml, p<0.0001). Patients who were 100% FR exhibited a decreased incidence of mortality (20.2%) compared to patient with 0% incidence FR (35.5%, p= 0.028). CONCLUSIONS: Short-term sepsis resuscitation phenotypes based responses to PLR identify discrete patient sub-groups. We have previously shown patients who improve CO in response to the resuscitation exhibited improved outcome. The ability to respond to the addition of IV fluid by increasing CO and SV may improve perfusion and lead to decreased adverse events. As there were an equal number of septic patients in both groups, a 0% incidence of FR may reflect a reduced EF or cardiac dysfunction instead of peripheral leakage. The results provided by a real time dynamic assessment may predict patient outcome and demonstrate physiology based on fluid responsiveness. CLINICAL IMPLICATIONS: Monitoring cardiac function closely is a high priority to prevent clinically relevant changes in patient outcome. DISCLOSURES: Employee relationship with Cheetah Medical Please note: >$100000 by Douglas Hansell, value=Salary Stock Holder relationship with Baxter Please note: 13 years Added 03/29/2022 by Kai Harenski, value=Stocks No relevant relationships by Muhammad Ali Javed Speaker/Speaker's Bureau relationship with Cheetah Medical Inc Please note: $1001 - $5000 by Heath Latham, value=Consulting fee Removed 03/28/2022 by Heath Latham Speaker/Speaker's Bureau relationship with Baxter Please note: 1/2021 - 3-2022 Added 03/28/2022 by Heath Latham, value=Consulting fee Employee relationship with Baxter Healthcare Please note: 15 months by Jennifer Sahatjian, value=Salary

Cardiac output change predicts patient outcome

Introduction: Cardiac function is known to be negatively impacted by sepsis. Monitoring Cardiac Output (CO) trends over the course of treatment may provide insight into cardiac function and may be used to predict patient outcome. The goal of this study was to explore the relationship between the change in stroke volume and outcome in critically ill patients. Methods: The Starling Registry study is an observational registry study evaluating trends in CO and SV (Stroke Volume) over time as related to patient outcome (NCT04648293). Patients that exhibited an overall improvement in CO (first CO measurement compared to last CO measurement) were compared to those who did not exhibit improvement. Results: A total of 229 critical care patients received hemodynamic monitoring during their ICU stay across three different hospitals. 48% were female, and the average age was 64 years. 64% of the patients had sepsis, and 17% of patients were positive for COVID. Notably, patients who exhibited an overall improvement in CO exhibited a decrease need for mechanical ventilation (4.8% vs 15%, p = 0.041) and a trend toward a decrease in mortality (16.4%) compared to those who did not improve (28.0%, p = 0.080) (Fig. 1). Conclusions: We have previously shown that patients who show an improvement in CO in response to the resuscitation exhibited improved outcome. Trending cardiac output over a 1-3 day monitoring period revealed additional usefulness in predicting patients with improved outcome. These results highlight the importance of trending hemodynamics in therapy. (Figure Presented).

Stroke volume change predicts patient outcome

INTRODUCTION: Cardiac function is known to be negatively impacted by sepsis. Monitoring Cardiac Output (CO) and Stroke volume (SV) trends over the course of treatment may provide insight into cardiac function and may be used to predict patient outcome. The goal of this study was to explore the relationship between the change in stroke volume and outcome in critically ill patients. METHODS: The Starling Registry study is an observational registry study evaluating trends in CO and SV over time as related to patient outcome (NCT04648293). Patients that exhibited an overall improvement in SV (first SV measurement compared to last SV measurement) were compared to those who did not exhibit improvement. RESULTS: 127 critical care patients received hemodynamic monitoring during their ICU stay across two different hospitals. 51 % were female, and the average age was 64 years. 64% of the patients had sepsis, and 15% of patients were positive for COVID. The average time between first and last SV measurement was approximately 7 hours. Notably, patients who exhibited an overall improvement in SV exhibited a decrease in mortality (14.9%) compared to those who did not improve (35.0%, p=0.018) CONCLUSIONS: We have previously shown that patients who show an improvement in SV in response to the resuscitation exhibited improved outcome. Trending cardiac output over a 1-3 day monitoring period revealed additional usefulness in predicting patients with improved outcome. These results highlight the importance of trending hemodynamics in therapy.