Value Of Aortic Peak Flow Velocity Variability In Volume Management In Patients With Septic Shock

Objective:Septic shock is a common critical illness in ICU wards.This article aims to evaluate the volume responsiveness of patients with septic shock and evaluate its clinical value in volume management in patients with septic shock by using volume loading test combined with Aortic peak flow velocity variability（△peak）.Methods:This trial is a prospective,interventional study method,including patients admitted to the intensive care department of Chengde Medical College from September 2021 to March 2023,who were divided into ultrasound and CVP decision groups according to the principle of randomized control.Both groups were given a volumetric stress test prior to fluid resuscitation。The ultrasound decision group measured△Peak before and after the volume stress test,evaluated the patient’s volume responsiveness according to△peak,and guided fluid resuscitation until the resuscitation goal was completed or reached 6hours.The CVP decision group measured CVP before and after the capacity load test and calculated△CVP.Combine initial CVP and△CVP levels to develop a fluid resuscitation strategy until resuscitation goals are met or 6 hours are reached.CVP,MAP,HR,and Lac,Pcv-a CO₂,Scv O₂,LCR and other important laboratory indicators,cumulative fluid balance,rate of resuscitation target,length of ICU hospitalization,duration of mechanical ventilation,duration of vasoactive drug use,the incidence of fusion B line in>2 regions,and28-day mortality were observed.P<0.05 was considered as a statistically significant differenceResults:1.General InformationA total of 106 patients with septic shock were included in this experiment,which were divided into ultrasound decision group（58 cases）and CVP decision group（48 cases）according to the principle of randomized control.According to the exclusion criteria,53 cases and 42cases in ultrasound decision group and CVP decision group,respectively.There were no significant differences in age,sex,APACHE II score,and site of infection（P>0.05）.2.Comparison of physiological and laboratory indicators before and after fluid resuscitation in the two groupsHeart rate（HR）in both groups at 3h,6h,12h,24h,and 48h after resuscitation,central venous-arterial carbon dioxide partial pressure difference（Pcv-a CO₂）,Lactate（Lac）were lower than before liquid resuscitation（0h）（P<0.05）;Mean arterial pressure（MAP）,central venous pressure（CVP）,central venous oxygen saturation（Scv O₂）were higher than before fluid resuscitation（0h）（P<0.05）,Comparison within and between groups at the other time points,There was no statistically significant difference（P>0.05）.3.Comparison of cumulative fluid balance after treatment between the two groups of patientsWithin 0-72 h of treatment,the cumulative fluid balance in the ultrasound decision group was significantly lower than that in the CVP decision group（P<0.05）.However,within 0-24 h and 0-48 h,the cumulative fluid balance in the ultrasound decision group was lower than that in the CVP decision group,but the difference was not statistically significant（P>0.05）.4.Comparison of the two groups of main observation indicatorsCompared with the 6-hour resuscitation target achievement rate of the two groups,the ultrasound decision group was higher than that of the CVP decision group（73.6%vs.66.7%）,and the ultrasound decision group was slightly lower than that of the CVP decision group（28.3%VS28.6%）,and the difference was not statistically significant（P>0.05）.However,the 6h lactate clearance rate（LCR）in the ultrasound decision group was significantly higher than that in the CVP decision group,and the incidence rate of fusion B line in>2 regions was significantly lower than that in the CVP decision group,and the difference was statistically significant（P<0.05）.5.Secondary observation indicators in both groupsThe duration of ICU stay,mechanical ventilation and use of vasoactive drugs in both groups in comparison,the ultrasound decision group was significantly lower than the CVP decision group,and the difference was significant（P<0.05）.6.Univariate analysis influencing poor prognosis in patients with septic shockFor 95 patients are divided into death group and survival group,death group 6h LCR is significantly lower than survival group,APACHE II score,72h cumulative fluid balance,>2 regional fusion B line incidence significantly higher than the survival group,differences are significant（P<0.05）,and binary Logistic regression analysis shows that 6h LCR,APACHE II score,72h cumulative fluid balance is the main risk factors of death in patients with septic shock.Conclusions:1.This study showed that the volume load test,guiding the traditional rehydration test（△CVP 2-5 principle）,reduce the positive fluid balance at 72h,increase the 6 h LCD of septic shock patients,manage early fluid volume,restore the tissue perfusion level,reduce the risk of pulmonary edema and tissue edema,reduce the use of vasoactive drugs and mechanical ventilation time.2.Low lactate clearance,high APACHE II score,and high cumulative fluid balance at 72 hours are major risk factors for death in patients with septic shock.