Effect Of Bedside Ultrasound And Passive Leg Raising Test On Assessment Of Fluid Responsiveness In Septic Shock Patients

Background:Septic shock is one of the critical diseases of intensive care unit(ICU).Early and reasonable fluid resuscitation is an indispensable and important therapy for patients with septic shock.But excessive fluid treatment can lead to the deterioration of the patient's condition.In the assessment,volume state is the state of the heart's preload.While the fluid responsiveness refers to an phenomenon that after rapid volume expansion,stroke volume(SV)and cardiac output(CO)can be increased evidently.In recent years,studies have found that passive leg raising test combined with measuring stroke volume and other surrogate markers could predict fluid responsiveness.The development of transthoracic echoeardiography makes bedside ultrasound assessment for ICU patients during the clinical work possible.It can be used to obtain the stroke volume and cardiac output in patients,which makes the passive leg raising test in determining the fluid responsiveness of patients is more accurate and convenient.Objective:To investigate the value of bedside ultrasound assessment of hemodynamic indexes before and after passive leg raising test to predict fluid responsiveness in patients with septic shock.Methods:51 septic shock patients were enrolled and allocated to fluid responsiveness group(n=27)and reactive group(n=24)according to fluid resuscitation results(after fluid resuscitation,whether increasing of stroke volumn was more than 15%at baseline).The changes in hemodynamic indexes of two groups were monitored by bedside ultrasound before and after passive leg raising test and after fluid resuscitation.Results:After passive leg raising test,stroke volume(62.12± 11.31 vs.71.14±8.09(ml),P=0.004),cardiac output(6.24±1.07 vs.6.82±1.52(L/min),P=0.026)and central venous pressure(10.81±4.13 vs,14.12±3.51(mmHg),P=0.001)were significantly increased in patients in the fluid responsiveness group.Then the hemodynamic indexes decreased when they finished the passive leg raising test(P>0.05).All these indexes were significantly increased again after fluid resuscitation in the fluid responsiveness group(P<0.05).However,the changes in the diameter of the inferior vena cava did not appear.When patients accept the passive leg raising test,the change in rate of stroke volumn was 7.95%and the area under the ROC curve was 0.878(P=0.006)had the highest sensitivity and specificity to predict positive of fluid responsiveness.Conclusion:The passive leg raising test combined with bedside ultrasound on assessment of hemodynamics in septic shock patients can effectively evaluate the fluid responsiveness of the early fluid resuscitation.