The Clinical Research Of NICaS For Monitoring Changes Of Cardiac Function In Patients With Sepsis

Myocardial Depression(MD)is quite common in patients with sepsis,and is 20% higher in mortality than patients with normal cardiac function.One of the “golden standards” currently used to diagnosis MD is transthoracic ech0cardiography(TTE)showing that the LVEF is less than 50%.Nowadays the Non-invasive body bioelectrical impedance Cardiac output monitoring System(NICa S)shows great potential promise in monitoring hemodynamics.Studys shows that the average CI using NICa S has significant relevance with figures using Fick and thermodilution methods,and the NICa S is non-invasive,convenient and easy-operating with high accuracy,repeatability and reliability.However,most of the study focus on evaluating the cardiac function in chronic cardiac insufficiency patients,and few has down in sepsis patients.The literature verifies that the GGI measured by NICa S with less than 10 correspond with EF less than 55%,and GGI no less than 10 correspond with EF no less than 55% in different levels.Our study tests EF,CO,HR,SV,CPI and GGI in sepsis patients using NICa S and cardiac color ultrasound and then employ correlation analysis to evaluate the clinical values of NICa S in measuring cardiac function in sepsis patients.Besides,we use NICa S to test the hemodynamics change of dobutamine stress echccardiography in septic shock patients,and perceive better understanding about the rule of the cardiovascular reactivity in prognosis evaluation.The purpose of this study is to evaluate the cardiac function of sepsis with non-invasive method,to discovery the myocardial depression timely,and to anticipate the prognosis,which has great value in clinic endeavor.Part ? The comparison of NICa S and Ultrasonic Cardiogram in measuring cardiac function of sepsis patients.OBJECTIVE: To observe the cardiac function changes in sepsis patients,and to understand the practical value of NICa S and Ultrasonic Cardiogram in measuring cardiac function of sepsis patients.METHODS: 46 cases with sepsis and 30 cases of healthy subjects admitted in Changzheng Hospital from Qct..2016 to Feb.2017 were input to database of the study.All into the group of patients were signed informed consent.After gathering the basic information,we use NICa S and bedside Ultrasonic Cardiogram to test the cardiac function of the patients including HR,CO,SV,EF,CPI and GGI.RESULTS:(1)Basic information :Within the group of healthy subjects there are 12 males and 18 females included with average age of 50.8±13.6.,and in sepsis group there are 22 males and 24 females included with average age of 56.8±15.4.Among all the sepsis cases,there are 26 hypertension patients(56.5%),15 coronary heart disease patients(32.6%),5 valvular lesions patients(10.9%)and 2 pulmonary arterial hypertension patients(4.35%)and 12 septic shock patients(26%).(2)Cardiac function analysis shows no significance(P>0.05)between NICa S and Ultrasonic Cardiogram in measuring CO and SV in both groups.(3)Simultaneous results of CO,CPI,GGI through NICa S and CO through Ultrasonic Cardiogram shows relevance with r of 0.986(P<0.001),0.484(P=0.001)and 0.323(P=0.028)perspectively,GGIthrough NICa S and EF through Ultrasonic Cardiogram shows relevance with r of 0.685(P<0.001).(4)T test result shows significance(P<0.05)between SV in sepsis and SV in healthy subjects,but CO in sepsis and CO in healthy subjects shows no significance(P>0.05).CONCLUSION:(1)sepsis patients has lower stroke volume,but cardiac output remain normal,which indicates hyperkinetic circulatory state.(2)NICa S can measure the cardiac output and stroke volume in sepsis patients as accurate as ultrasonic Cardiogram,and the exclusive GGI figure NICa S has has a positive correlation with EF of Ultrasonic Cardiogram but without significance,which may attributed to the fact that the GGI is figure that only reflect the intrinsic myocardial contractility of left ventricle whereas the preload and afterload of the left ventricle could also influence the cardiac output.Part ? Relationship between hemodynamics and prognosis in patients with septic shock monitored with NICAS under dobutamine stress testOBJECTIVE: To investigate the role of cardiovascular system responsiveness in prognosis in patients with septic shock with NICAS monitoring.METHODS: A prospective,non-randomized,non-double-blind study was conducted to select 96 patients(sepsis3.0 diagnostic criteria)for septic shock from ICU in October 2016 to March 2017.All into the group of patients were signed informed consent.Appropriate patients were selected according to the inclusion and exclusion criteria.Informed consent should be signed by all informed patients.(1)The general information about the patients' status,including gender,age,site of infection,mechanical ventilation,and indicators of organ dysfunction such as lung,kidney,liver and coagulation system,including oxygenation index(Pa O2 / Fi O2)(SCr),total bilirubin(TBil)and platelet count(PLT),lactic acid,hemoglobin(Hb)etc.Parallel acute physiology and chronic health status scoring system ?(APACHE II)score and sequential organ failure score(SOFA)were used to study.(2)Under guidance of CVP to adjust the optimal preload,(to maintain CVP8-12 mm Hg,mechanical ventilation CVP15 mm Hg or so),adjust the baseline Vasoactive drug dose to maintain blood pressure ? 65 mm Hg.Baseline hemodynamics data were measured using NICAS at the same time as the baseline of the dobutamine stress test.At the same time,arterial and mixed venous blood samples were taken for blood gas analysis,and the p H,oxygen partial pressure(Pa O2),carbon dioxide partial pressure(Pa CO2),and arterial oxygen saturation(Sa O2).(3)Dobutamine Stress Test: Dobutamine 5?g / kg / min was injected intravenously via the central vein and then increased by 5 ?g / kg / min per 10 min until the maximum dose reached 15 ?g / kg / min.The thermodynamic parameters of bedside NICa S were measured after 30 min of phentolamine injection.Medication continued to rehydration process,use of vasoconstrictor drugs,anti-infection and other symptomatic support to maintain CVP8-12 mm Hg and MAP?65mm Hg.To keep the environment quiet,mechanical ventilation patients with moderate sedation to reduce the external stimuli,all patients in ICU;routine ECG and oxygen saturation monitoring during the study.Discontinuation of the end point: 1)medication in the process if any of the drug side effects should be immediately Stop dobutamine injection,such as ventricular premature beats such as ventricular premature beats,heart rate more than the age of the highest heart rate of 85% or significant chest pain,ST segment depression.2)After reaching the maximum dose of 15?g / kg / min for 5min,dobutamine decreased gradually and stopped within 20 min.(4)Observe the survival of patients after ICD 28 d.RESULTS:(1)The 28-day clinical outcome was divided into survival group and death group.Among them,64 survived(male 38 / female 26)and 32 died(male 14 / female 18).There were no significant differences in gender,age,mechanical ventilation,and infection between the two groups.(2)The difference between the baseline platelet count(P = 0.01),Acute Physiology and Chronic Health Score System II(APACHE II)and SOFA score(P = 0.01)was statistically significant.The remaining indicators including vasoactive drug dose,Pa O2 / Fi O2,SCr,TBil,Lactic Acid and Hb were not statistically significant.(P <0.05).(3)GGI,oxygen transport and peripheral vascular resistance were lower than those of survivors(P <0.05).The baseline heart rate hemodynamics data(SBP),diastolic blood pressure(DBP),mean arterial pressure(MBP),cardiac index(CI),stroke volume index(SI),and cardiac work index(CPI)were not significantly different.(4)The increase of ?SVI,?CI,?CPI and ?GGI was more significant than that in the death group(P <0.05).The decrease of ?TPRI was more significant than that in the death group(P <0.05).(5)Logistic univariate regression analysis showed that the baseline heart rate,?CI,?SVI,?GGI,?CPI,and ?DO2I were significantly lower than those in the control group(P <0.05).The multivariate logistic regression analysis was performed without the heart rate,?SVI and ?DO2I,which were significantly correlated with ?CI.The results showed that ?CI was an independent predictor of survival in patients with septic shock and ?TPRI was an independent predictor of death.CONCLUSION:(1)In patients with sepsis thrombocytopenia,high SOFA score indicates that the patient is in critical condition and the prognosis is poor.(2)sepsis patients with too fast heart rate suggest poor prognosis.(3)The response of the cardiovascular system was closely related to the prognosis of the dobutamine stress test.The related indexes(such as SVI,CI,GGI,CPI)in the survival group were significantly higher than those in the death group.Cardiovascular system responsiveness under catecholamine stress is more predictive than the initial hemodynamic index,and the prognosis is superior to nonrespondability in terms of prognosis.(4)?CI is an independent predictor of death in patients with septic shock,and ?TPRI is an independent predictor of death.