Clinical Studies Of Fluid Resusciation According To Aortic Peak Flow Velocity Variability On Severe Septic Patients

Objective: To guide fluid resuscitation of patients with severe sepsis based on the aortic peak flow velocity variability(△Peak) guided by the fluid challenge, to evaluate its role in severe septic patients for fluid resuscitation.Methods: The study was a prospective, randomized control, intreventional study.Severe septic patients in Intensive Care Unit of the fourth hospital of Hebei Medical University from March 2014 to January 2015 were enrolled and randomly divided into two groups using the randomized controlled principles, ultrasound guide group and usual care group. For patients in the ultrasound guide group, we will use ultrasound to detect aortic peak flow velocity variability after fluid challenge(within 3 minutes of the infusion 300 ml compound sodium chloride injection) and then determine whether to start fluid resuscitation; If △Peak≥12%, patients has fluid responsiveness, following which patients may be intravenous infused 500 ml compound sodium chloride injection within 30 minutes, move in circles until the accomplishment of EGDT. If △Peak<12%, patients hasn’t fluid responsiveness, which patients aren’t positive for fluid resuscitation, then after assessment by clinicians decide the follow-up treatment. For patients in the usual care group, all treatments were made by the clinicians. The physiological and laboratory variables, the amount of fluid resusciation, the complicance rate of EGDT, duration of hospital stay, duration of ICU stay, duration of mechanical ventilation, duration of vasopressor support, the amount of vasopressor, the 7 days mortality and the 28 days mortality.Result:1 We enrolled 70 patients and randomly divided into two groups using the randomized controlled principles, ultrasound guide group(n=37) and usual care group(n=33), finally completed the experiment ultrasound guide group(n=34) and usual care group(n=29). There was no significant differences between the both groups in age,sex,weight,APACHE II score,SOFA score and the source of infection.2 Comparison of vital physiological and laboratory signs in both groups before and after fluid resuscitationAfter fluid resuscitation 6h, 12 h and 48 h, the HR, RR, LAC, Pcv-a CO2 values were lower than before fluid resuscitation(all P<0.05); the Sp O2, CVP, Scv O2 were higher than before fluid resuscitation(all P<0.05). There were no significant differences between the both groups at each time point.3 Comparison of the amount of fluid in both groups after fluid resuscitationThe amount of fluid intake and fluid positive banlance within 0-6h in the ultrasound guide group increased significantly compared with the usual care group(P<0.05). The amount of fluid banlance within 0-7 days in the ultrasound guide group was significantly less than that of usual care group(P<0.05).There were no significant differences between the both groups at fluid intake, outtake and banlance in other time point.4 Comparison of the complicance rate of EGDT in both groupsThere were no significant differences between the both groups(P=0.129), but the ultrasound guide group compliance rate is higher than the usual care group(76.5 vs. 58.6%).5 Comparison of the duration of hospital stay, ICU stay, and mechanical ventilation in both groupsThere were no significant differences between the both groups in duration of hospital stay and ICU stay. Duration of mechanical ventilation was significantly reduced in the ultrasound guide group compared with the usual care group(P<0.05).6 Comparison of the amount of vasopressor and duration of vasopressor support in both groupsThe amount of vasopressor in the ultrasound guide group was significantly less than that of usual care group, and the duration of vasopressor support was significantly reduced in the ultrasound guide group compared with the usual care group(P<0.05).7 Comparison of the mortality in both groupsThere were no significant differences between the both groups in the 7 days mortality and the 28 days mortality.Conclusion: The aortic peak flow variability guided by the capacity load test to evaluate the volume responsiveness on severe sepsis patients, then to guide the fluid resuscitation, was more precisely in terms of fluid management than the usual care, which can avoid the blind fluid treatment, reduce the amount of vasopressor, shorten duration of vasopressor support and mechanical ventilation.