Predictive Value Of Small Dose Volume Loading Test For Fluid Responsiveness In Septic Patients

Objective:To evaluate the predictive value of all liquid reaction on sepsis-induced cardiac dysfunction patients in small dose volume stress test,and provide clinical reference and theoretical basis for sepsis treatment with reasonable expansion treatment.Mmethods:22 patients,diagnosed as sepsis-induced cardiac dysfunction after enrolled by the emergency department of our hospital from August 2015 to January 2017 as subjects.All patients were given routine treatment,then operated mechanically ventilated,subclavian vein catheterization and femoral artery puncture PICCO catheter,the implementation of PICCO stress testing.We measured the HR,MAP,CVP,CO,PPV,SVV,EVLW as T0 before the low volume fluid challenge.The above parameters were re-measured as T1 after rapid infusion of 100 ml 0.9% sodium chloride in 1 min.30 mins later,the parameters were measured again as T2 after infusion of 500 ml 0.9% sodium chloride in 30 mins.We got the mean value of each parameter after 3 continual measurements.Fluid responsiveness was defined as an increase in the CO>10%.The patients were separated into positive group and negative group.The increase rate of CO in T1 is ?CO.EVLW were measured at various time-points(T0,T1,T2),to see whether there were differences in outcomes according to the statistical analysis of T1,T2 and T0.?CO,PPV and the sensitivity and specificity of CVP were analyzed with ROC.Result:1 According to the reactivity to liquid,12 cases of positive group and 10 cases of negative group.Comparing the two groups' clinical data,there is no significant difference.(P>0.05).2 The AUC under the ROC curve of ?CO was 0.85(95% CI: 0.79-1.01).The best cutoff value was 0.15(sensitivity =0.85,specificity=0.70).3 The EVLWI in T1 was not statistically significant compared with T0 and T2.However,the EVLW of the T2 group was significantly high compared with T0.(P=0.0001)4 Comparing the responsiveness of volume responsiveness predictors(?CO,PPV,CVP)under the AUC ROC curve,the predictive sensitivity and specificity of ?CO is best.Conclusion:1 The application of low volume fluid stress testing is safe in patients with sepsis and cardiac dysfunction,?CO is a useful predictor of low volume fluid stress of fluid responsiveness in septic patients with cardiac dysfunction,sensitivity =0.85,specificity=0.70.2 The ?CO and PPV are better than CVP in low volume fluid challenge.