Study On The Clinical Value Of Bedside Ultrasound In Evaluating The Fluid Responsiveness Of Patients With Septic Shock

Objectives Ultrasonography was performed to evaluate each hemodynamic parameter to predicte the fluid responsiveness of the patients with septic shock, the variation of each hemodynamic parameter was analyzed and the cutoff points of each hemodynamic parameter was screened out in predicting the fluid responsiveness according to the change of stroke volume before and after the volume expansion(VE) text, thus the applied value of each hemodynamic parameters was explored by ultrasonography in predicting the fluid responsiveness.Methods The study was performed and forty-two mechanically ventilated patients with septic shock who admitted to the intensive care unit(ICU) of the Affiliated Hospital of North China University of Science and Technology from november 2014 to october 2015 were included. All patients were treated with VE text and totally conducted in 47 cases.Ultrasonography was executed to measure each index before and after the VE text, such as Left ventricular outflow tract diameter(D). Hemodynamic indexes were obtained by calculation before and after the VE test, for example, stroke volume(SV), Left ventricular outflow tract peak blood flow velocity variation rate of breathing(?Vpeak LOVT). Monitoring record of clinical index at the same time such as central venous pressure(CVP), etc. Based on the responsiveness of SV by Transthoracic chocardiography, the patients were divided into responsive(R) group and non-responsive(NR) group, 25 and 22 cases respectively. The data was stored immediately which that all ultrasonic data measured three times and take the average. The indicators were analyzed immediately. Excel was used to establish a database, SPSS17.0 statistical analysis software was used for statistical analysis, all measurement data used by mean±standard deviation(sx ±). Counting information was expressed as percent, which their comparison used chi-squared test. Group compared with paired t test, Comparison between groups was used with independent sample t-test. The correlation between two indicators was conducted with Spearman. AUC and the best diagnostic threshold obtained by the ROC curve of the values of the hemodynamic parameters to evaluate the fluid responsiveness.Results 1 There was no statistically significant difference(P>0.05) in the comparison of two groups of patients with general information—reaction group and non-reaction of two groups of age, sex, body mass index(BMI), tidal volume(TV), left ventricular ejection fraction(EF), the amount of liquid. 2 The comparison of two groups of patients with general hemodynamic: 1) There was no statistically significant difference about HR,MAP, CVP between R and NR before the VE text(P>0.05). 2) The MAP of the group of R was increased after the VE text, HR was decreased, the difference was statistically significant(P<0.05). There were no obvious changes about HR, MAP of the NR group after the VE text, there was no statistically significant difference(P>0.05). The parameter about CVP of the R and NR groups all was increased, the difference was statistically significant(P<0.05). 3 Each parameter value of the group of R was higher than that of the group of NR, the difference was statistically significant(P<0.05). 4 The hemodynamic parameters of the group of R were reduced after the VE text, the difference was statistically significant(P<0.05). 5 Correlation analysis between the hemodynamic parameters and ?SV before VE test show that the hemodynamic parameterswere significantly related with ?SV, ?CVP is not related with ?SV. 6 The receiver-operating characteristic curve: The hemodynamic parameters in predicting the fluid responsiveness were higher reactivity and sensitivity.Conclusions 1 The value of each hemodynamic parameter abtained by the bedside ultrasound of the reactive group of septic shock patients such as ? IVC1 higher than the the no reactive group before the VE test. 2 The value of hemodynamic indexe such as?IVC1 was decreased obviously which obtained by bedside ultrasound of group of R with septic shock patients after the VE test. 3 The hemodynamic parameters such as ?IVC1 by bedside ultrasound were correlated with ?SV. Indicating that the hemodynamic parameters could predict the volume responsiveness in septic shock patients with mechanically ventilated. 4 The value of hemodynamic parameters such as ?IVC1 were excess or equal to the dividing value, which that judging patients have higher value of fluid responsiveness. 5 The greater of the value of the hemodynamic indexes in its value within a certain range, the better, which evaluate the fluid responsiveness patients with septic shock patients. 6 It is important that bedside ultrasound, which predicte the fluid responsiveness of patients with septic shock in clinical value.