Assessing The Capacity Reactivity Of Septic Shock By PICCO And Color Doppler Ultrasound

Background and ObjectiveSeptic shock,a subtype of sepsis,refers to patients with sepsis,despite adequate fluid resuscitation,still have sustained hypotension and need to use the booster to maintain the average arterial pressure above 65 mmHg,serum lactate levels in more than 2 mmol / L(18 mg / dL).Severe sepsis and septic shock are the major health problems affecting humans,with millions of patients infected with the disease each year,of which a quarter or more of the patients died,and similar to multiple trauma,acute myocardial infarction or stroke.Sepsis after the timely take appropriate treatment options,most likely affect the prognosis of patients.To assess the volume responsiveness of septic shock patients,which was cond????ted by pulse indicates continuous cardiac output(PICCO)monitoring the stroke volume variation(SVV)and color doppler ultrasound monitoring of the inferior vena cava diameter(IVCD)and respiratory Variation Index(RVI),monitor the fluid resuscitation in patients with septic shock.MethodsCardiac output(CO),cardiac index(CI),heart rate(HR),stroke volume variation rate(SVV),mean arterial pressure(MAP)were monitored by PICCO,and the maximum and minimum diameter of the inferior vena cava(IVCDmax,IVCDmin)for inhale and exhale before and afterinfusionwere recorded by colourdopplerultrasound of bedside for 40 septic shock patients by prospective cohort study.RVI =(IVCDmax-IVCDmin)/ IVCDmax × 100%.500 ml compound sodium chloride was infused for the patients by vein rapidlyin20 min,?CI?15% was defined as the capacity of response group,?CI <15% was defined as the capacity of non-response groupafter the infusion.Compare the changes of hemodynamic parameters,SVV and RVI in the two groups before and after fluid replacement.Evaluate the response capacity was compared with SVV and RVI in the capacity of response group after rehydration,and the correlation between SVV,RVI and ?CI.Besides,the sensitivity and specificity of SVV and RVI were analysised by the receiver operating characteristic curve(ROC curve).ResultsIn 40 patients,26 cases were responded to the capacity,and the rest were no response.SVV and RVI were positively correlated with ?CI after infusion,and the SVV and RVI have a certain correlation(r = 0.859,P<0.01);The area of ROCsvv?ROCrvi under the ROC curve were 0.841 ± 0.061,0.858 ± 0.057 respectively,which had no significant statistically difference,and 95% confidence interval were 0.721 to 0.961,0.746 to 0.971 respectively.The sensitivity of responsiveness was predicted SVV was 11%(sensitivity was 83.6%,specificity was 81.4%),and the RVI was 26%(sensitivity was 87.1%,specificity was 83.8%).ConclusionsSVV and RVI can effectively assess the capacity reactivity of mechanical ventilation septic shock reactivity,and has a good correlation,can monitor and guid the liquid recovery of the above-mentioned patients.