The Value Of Mitral E-peak Velocity Respiratory Variation In The Evaluation Of Fluid Responsiveness In Sepsis And Septic Shock Patients

Objective To explore the Value of mitral E-peak velocity respiratory variation in the evaluation of fluid responsiveness in sepsis and septic shock patients via ultrasonic measurement of E-peak flow velocity of mitral valve,left ventricular outflow tract(LVOT)peak flow velocity and respiratory variation.Methods 1.Participants: Consecutive patients with sepsis and septic shock without spontaneous respiratory trigger in ICU of Lianyungang first people’s Hospital were included in the study from May 2017 to January 2018.2.Methods of study: all patients received early resuscitation for 30 ml / kg crystalloid solution infusion within 3 hours.Patients who had completed early resuscitation before admission went directly to the next step.In the patients with persistent hypotension,Vasoconstrictor(dopamine or norepinephrine)was added to maintain the mean arterial pressure ≥ 65 mm Hg.The gender,age,diagnostic Apache Ⅱ score,ventilator tidal volume,plateau pressure,PEEP,Heart rate,blood pressure were recorded.The internal diameter(D)and velocity time integral(VTI)of LVOT,the maximum and minimum values of mitral E-peak flow velocity(VEpeak)and LVOT peak flow velocity(Vpeak)were measured by ultrasound.Then,calculated stroke volume(SV1),respiratory variation of mitral E-peak velocity(△VEpeak)and LVOT peak flow velocity(△Vpeak).After a fluid challenge,Remeasure and calculate all of parameters.SV increment ≥ 15% was positive for fluid challenge.3.test: Prospective observational study,Non-Experimental correlation Analysis,single individual Bivariate sample.The results of fluid challenge were gold standard,the difference and correlation of mitral E-peak flow velocity and LVOT peak flow velocity and respiratory variation werecompared.The data were analyzed by SPSS19.0 software.The measured data were expressed as mean ±standard deviation.The matched t test was used for the comparison between groups,the scattered plot was drawn;The pearson correlation analysis was used to analyze the bivariate correlation.The difference was statistically significant(P < 0.05).The respiratory variation of mitral E-peak velocity and LVOT peak flow velocity was compared by using the operating characteristic curve(ROC)and the area under the curve(AUC)about the Predictive efficacy of fluid responsiveness in septic and septic shock patients,sensitivity,specificity,and accuracy of cutoff points were calculated.Results1.40 patients of sepsis and septic shock were included in this study,23 patients with positive fluid challenge were diagnosed(57.5%),the respiratory variation of mitral E-peak velocity(0.21±0.05),the respiratory variation of LVOT peak flow velocity(0.14±0.03).17 patients with negative fluid challenge were diagnosed(42.5%),the respiratory variation of mitral E-peak velocity(0.13±0.03),the respiratory variation of LVOT peak flow velocity(0.09±0.02).2.The respiratory variation of mitral E-peak velocity in sepsis and septic shock patients without spontaneous respiratory trigger(0.18 ±0.06)was higher than that in LVOT(0.12 ±0.04).The difference was statistically significant(P= 0.000).The maximum,minimum and average values was no significant difference between mitral E-peak flow velocity and LVOT peak flow velocity in patients with sepsis and septic shock.3.correlation analysis: The respiratory variation of mitral E-peak velocity in sepsis and septic shock patients without spontaneous respiratory trigger were correlated with the respiratory variation of LVOT peak flow velocity(r=0.898,P=0.000).4.ROC curve: The AUC of the respiratory variation of mitral E-peak velocity predicting fluid responsiveness in patients with sepsis and septic shock without spontaneous respiratory trigger was 0.931,95%CI 0.854~1.000,with 0.17 as the threshold to predict fluid responsiveness,the sensitivity was 0.826,the specificity was 0.941,and the Yorden index was 0.767.The AUC of the respiratory variation of LVOT peak flowvelocity predicting fluid responsiveness was 0.916,95% CI 0.820 ~ 1.000,with 0.11 as the threshold,the sensitivity was 0.826,the specificity was 0.882,and the Yorden index was0.708.Conclusion: The respiratory variation of mitral E-peak velocity can be used to predict fluid responsiveness in patients with sepsis and septic shock without spontaneous respiratory trigger.