The Systemic And Renal Perfusion Assessment By Renal Doppler During Fluid Resuscitation In Serve Sepsis

Objective: Renal doppler ultrasonography is a simple non-invasive tool and now more and more studies put forward that kidney ultrasound can be used to assess systemic and renal perfusion of the critically ill patients.The purpose of this study was to assess the significance of kidney ultrasound in estimating systemic and renal perfusion of patients with serve spsis during fluid resuscitation.Methods: Patients who were diagnosed severe sepsis were enrolled in the study from June 2014 to December 2014 in ICU of the fourth hospital of Hebei Medical University.40 patients in all were enrolled in the study at first,but 35 patients were enrolled at last because of various reasons. After admitted in ICU, the patients were treated symptomatically in time and the doctor-in-charge decided whether or not in accordance with the principle of EGDT to initiate fluid resuscitation.We should record general condition and clinical features of patients who send to ICU first time, and record various important physiological indexes and laboratory indexes of them before starting fluid resuscitation, after beginning fluid resuscitation 6h.We should initiate fluid challenge first before fluid resuscitation and estimate the volume responsiveness of patients by VTI% which was obtaind from echocardiogram.Then we should obtaind RRI and RBF classification by renal ultrasound fluid resuscitation before starting fluid resuscitation, after beginning fluid resuscitation 6h. According to the result of volume responsiveness and the creatinine and urine output change of patients, We divided the patients into volume responsiveness(+)group and volume responsiveness(-) group, also we can divided them into AKI(+) group and AKI(-)group.At last, we would compare hemodynamic change characteristics during fluid resuscitation in all patients were enrolled and patients were belong to different groups and analyze the relationship between hemodynamic change characteristics and the change of RRI, RBF classification.Results:1 Group situationThere were 20(57.1%) patients in Volume responsiveness(+)group and 15(42.9%) patients in Volume responsiveness(-)group. There were 17(48.6%) patients in AKI(+)group and 18(51.4%) patients in AKI(-)group.2 Hemodynamic change during fluid resuscitation in all patients were enrolled in our study and patients with different volume responsiveness and renal function.Compared with starting fluid resuscitation at first, all patients were enrolled in our study and patients were in Volume responsiveness(+)group had more lower HR,Cre and Lac after fluid resuscitation. They also had more higher SV and CVP.Patients were in Volume responsiveness(-)group just had lower HR after fluid resuscitation.Patients were in AKI(-)group had lower HR,Cre and Lac. Patients were in AKI(-)group had more lower HR and more higher SV, CVP.3 General condition, physiological indexes and laboratory indexes of patients with different Volume responsiveness during fluid resuscitationThere were no statistical differences between volume responsiveness(+) group and volume responsiveness(-)group in age, Gender, SOFA score, APACHE II score, Ramsay score, Sa O2, Body temperature, Fi O2 snd so on before starting fluid resuscitation.There were also no statistical differences between two groups in HR、MAP, Pulse pressure index, IAP, CVP, CO, SV, Lac before starting fluid resuscitation.There were statistical differences between two groups in HR(P=0.02), Lac(P=0.02) and Lac%(P=0.04) after beginning fluid resuscitation, but other index were not statistical differences.4 General condition, physiological indexes and laboratory indexes of patients with different renal function during fluid resuscitationThere were no statistical differences between AKI(+)group and AK(-)group in age, Gender, SOFA score, APACHE II score, Ramsay score, Sa O2, Body temperature, Fi O2 snd so on before starting fluid resuscitation.There were also no statistical differences between two groups in HR、MAP, Pulse pressure index, IAP, CVP, CO, SV, Lac before starting fluid resuscitation,but RRI in AKI(+) group were significantly higher than RRI in AKI(-)group(P<0.001) and AKI(+) group also had lower RBF classification(P=0.003).There were no statistical differences between two groups in HR, MAP, Pulse pressure index, IAP, CVP, CO, SV, Cre Lac after beginning fluid resuscitation, but RRI in AK(+)group were also significantly higher than RRI in AKI(-)group(P<0.001) and AKI(+)group also had lower RBF classification(P=0.003). In addition, AKI(+)group also had higher RRI%(P=0.01)than AKI(-)group.5 The change of RRI and RBF of all patients were enrolled in our study and patients with different volume responsiveness and renal function classification during fluid resuscitation;the relationship between RRI and hemodynamic changeIn all patients were enrolled in our study, there were no statistical differences in RRI during fluid resuscitation(P=0.133). Similarly, there were also no relationship between RRI% and SV%( r2=0.301, P=0.079), RRI% and Lac%( r2=0.012, P=0.536),but there was a significant rise in RBF classification during fluid resuscitation(P<0.001).In volume responsiveness(+)group, there were no statistical differences in RRI during fluid resuscitation(P=0.570). Similarly, there were also no relationship between RRI% and SV%( r2=0.102, P=0.171), RRI% and Lac%( r2=0.073, P=0.250),but there was a significant rise in RBF classification during fluid resuscitation(P=0.003).In volume responsiveness(-)group, there were no statistical differences in RRI during fluid resuscitation(P=0.157). Similarly, there were also no relationship between RRI% and SV%( r2=0.131, P=0.185), RRI% and Lac%( r2=0.004, P=0.828).And there was not rise in RBF classification during fluid resuscitation(P=0.05).In AKI(+)group, there were statistical differences in RRI during fluid resuscitation(P=0.004).But there were also no relationship between RRI% and SV%( r2=0.032,P=0.902), RRI% and Lac%( r2=0.039, P=0.880). Furthermore, there was was a significant rise in RBF classification during fluid resuscitation(P=0.007).In AKI(-)group, there were no statistical differences in RRI during fluid resuscitation(P=0.449),but there was was a significant rise in RBF classification during fluid resuscitation(P=0.008).Conclusions:1 The improvement of systemic hemodynamics and renal perfusion during fluid resuscitation in serve sepsis could not be translated into the change of RRI by renal colour doppler, in other words, RRI by renal colour doppler could not be used to assess the change of systemic hemodynamics and renal perfusion;2 RBF classification by renal colour doppler could be used to assess the change of systemic hemodynamics and renal perfusion;3 RRI by renal colour doppler could help to identify AKI patients earlly and could become a dynamic indicator to assess renal perfusion in patients with AKI.