Vojnosanitetski pregled 2023 Volume 80, Issue 5, Pages: 439-445
https://doi.org/10.2298/VSP220215069H
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Application value of bedside ultrasound for assessing volume responsiveness in patients with septic shock
He Hao (The Fourth Hospital of Changsha, Department of Critical Care Medicine, Changsha, Hunan Province, China)
Pan Nifang
Zhou Xiaoyong (Fudan University, Jinshan Hospital, Center of Emergency and Intensive Care Unit, Shanghai, China + Fudan University, Jinshan Hospital, Medical Center of Chemical Injury, Shanghai, China + Fudan University, Jinshan Hospital, Medical Research Center for Chemical Injury, Emergency and Critical Care of Chemical Injury, Shanghai, China), zhouxyjhfu@protonmail.com
Background/Aim. Septic shock (SS) is a complication that can occur as a consequence of an infection. As the effective circulating blood volume is of great importance in these cases, keeping constant track of the blood volume parameter is essential. The aim of this study was to explore the application value of bedside ultrasound for assessing volume responsiveness (VR) in patients with SS. Methods. A total of 102 patients with SS were selected. The volume load (VL) test was performed, and based on the results of the test, the patients were divided into two groups. The first group was the response (R) group, which had an increase in stroke volume (ΔSV) ≥ 15% after the VL test, and the second was the non-response (NR) group, with ΔSV < 15% after the VL test. There were 54 patients in the R group and 48 in the NR group. Hemodynamic parameters were compared before and after the VL test. The correlation between ΔSV and each hemodynamic index was explored by Pearson’s analysis. The receiver operating characteristic (ROC) curves were plotted for some of the parameters. Results. Before the VL test, retro-hepatic (RH) inferior vena cava (IVC) (RHIVC) distensibility (ΔRHIVC1) index, respiratory variation in RHIVC (ΔRHIVC2) index, respiratory variation in aortic (AO) blood flow peak velocity (ΔVpeakAO) index, respiratory variation in brachial artery (BA) blood flow peak velocity (ΔVpeakBA) index, and respiratory variation in common femoral artery (CFA) blood flow peak velocity (ΔVpeakCFA) index were all higher in the R group than those in the NR group (p < 0.05), while heart rate (HR), mean arterial pressure (MAP), and central venous pressure (CVP) were similar in both groups (p > 0.05). After the VL test, the R group had significantly decreased values of HR and the ΔRHIVC1, ΔRHIVC2, ΔVpeakAO, ΔVpeakBA, and ΔVpeakCFA indices, while the MAP and CVP values (p < 0.05) were increased. The NR group had a significantly decreased value of CVP (p < 0.05), while no significant changes were noticed in the values of other indices. The indices ΔRHIVC1, ΔRHIVC2, ΔVpeakAO, ΔVpeakBA, and ΔVpeakCFA significantly correlated with ΔSV (r = 0.589, r = 0.647, r = 0.697, r = 0.621, r = 0.766, respectively; p < 0.05), but there was no correlation between CVP and ΔSV (r = -0.345; p > 0.05). The areas under the curve (AUC) of ROC graphics for ΔRHIVC1, ΔRHIVC2, ΔVpeakAO, ΔVpeakBA, and ΔVpeakCFA indices, used for the prediction of VR, were 0.839, 0.858, 0.878, 0.916, and 0.921, respectively, and were significantly larger than the AUC of ROC graphic for CVP (0.691), indicating higher sensitivity and specificity of the ΔRHIVC1, ΔRHIVC2, ΔVpeakAO, ΔVpeakBA, and ΔVpeakCFA indices compared to CVP. Conclusion. Bedside ultrasound monitoring of the ΔRHIVC1, ΔRHIVC2, ΔVpeakAO, ΔVpeakBA, and ΔVpeakCFA indices can assess the VR in patients with SS more precisely.
Keywords: blood volume, hemodynamic monitoring, infusions, intravenous, saline solution, shock, septic, ultrasonography
Show references
Bataille B, de Selle J, Moussot PE, Marty P, Silva S, Cocquet P. Machine learning methods to improve bedside fluid responsiveness prediction in severe sepsis or septic shock: an observational study. Br J Anaesth 2021; 126(4): 826-34.
Zhuang Y, Dai L, Cheng L, Lu J, Pei Y, Wang J. Inferior vena cava diameter combined with lung ultrasound B-line score to guide fluid resuscitation in patients with septic shock. Zhong-hua Wei Zhong Bing Ji Jiu Yi Xue 2020; 32(11): 1356-60. (Chinese)
Chambers KA, Park AY, Banuelos RC, Darger BF, Akkanti BH, Macaluso A, et al. Outcomes of severe sepsis and septic shock patients after stratification by initial lactate value. World J Emerg Med 2018; 9(2): 113-7.
Zuccari S, Damiani E, Domizi R, Scorcella C, D'Arezzo M, Carsetti A, et al. Changes in Cytokines, Haemodynamics and Microcirculation in Patients with Sepsis/ Septic Shock Undergoing Continuous Renal Replacement Therapy and Blood Purification with CytoSorb. Blood Purif 2020; 49(1-2): 107-13.
Lu N, Jiang L, Zhu B, Han W, Zhao Y, Shi Y, et al. Variability of peripheral arterial peak velocity predicts fluid responsiveness in patients with septic shock. Zhonghua Wei Zhong Bing Ji Jiu Yi Xue 2018; 30(3): 224-9. (Chinese)
Corradi F, Via G, Tavazzi G. What's new in ultrasound-based assessment of organ perfusion in the critically ill: expanding the bedside clinical monitoring window for hypoperfusion in shock. Intensive Care Med 2020; 46(4): 775-9.
Airapetian N, Maizel J, Alyamani O, Mahjoub Y, Lorne E, Levrard M, et al. Does inferior vena cava respiratory variability predict fluid responsiveness in spontaneously breathing patients? Crit Care 2015; 19: 400.
Bughrara N, Diaz-Gomez JL, Pustavoitau A. Perioperative Management of Patients with Sepsis and Septic Shock, Part II: Ultrasound Support for Resuscitation. Anesthesiol Clin 2020; 38(1): 123-34.
Rhodes A, Evans LE, Alhazzani W, Levy MM, Antonelli M, Ferrer R, et al. Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016. Intensive Care Med 2017; 43(3): 304-77.
Mojoli F, Bouhemad B, Mongodi S, Lichtenstein D. Lung Ultrasound for Critically Ill Patients. Am J Respir Crit Care Med 2019; 199(6): 701-14.
Qi F, Cao L, Zhang LL, Wang Y, Guo WW, Li F. The predictive value of cardiopulmonary interaction monitoring technology on volume responsiveness in septic shock patients. Chin J Emerg Med 2019; 28: 869-74. (Chinese).
Vieillard-Baron A, Prigent A, Repessé X, Goudelin M, Prat G, Evrard B, et al. Right ventricular failure in septic shock: characterization, incidence and impact on fluid responsiveness. Crit Care 2020; 24(1): 630.
Kim JS, Kim M, Kim YJ, Ryoo SM, Sohn CH, Ahn S, et al. Troponin Testing for Assessing Sepsis-Induced Myocardial Dysfunction in Patients with SS. J Clin Med 2019; 8(2): 239.
Qi B, Yang WB, Zhang H, Li GZ, Cai JJ, Zhang WZ, et al. Clinical application of inferior vena cava inspiratory collapsibility in early goal-directed therapy of septic shock. Chin J Resp Crit Care Med 2020; 19: 246-50. (Chinese)
Si X, Xu H, Liu Z, Wu J, Cao D, Chen J, et al. Does Respiratory Variation in Inferior Vena Cava Diameter Predict Fluid Responsiveness in Mechanically Ventilated Patients? A Systematic Review and Meta-analysis. Anesth Analg 2018; 127(5): 1157-64.
Huan C, Lu C, Song B, Li PC, Ren HS, Chu YF, et al. The shape change index (SCI) of inferior vena cava (IVC) measuring by transabdominal ultrasound to predict the presence of septic shock in intensive care unit (ICU) patients. Eur Rev Med Pharmacol Sci 2019; 23(6): 2505-12.
Shrestha GS, Srinivasan S. Role of Point-of-Care Ultrasonography for the Management of Sepsis and septic shock. Rev Recent Clin Trials 2018; 13(4): 243-51.
Pei Y, Yang Y, Feng Y, He S, Zhou J, Jiang H, et al. Diagnostic accuracy of artery peak velocity variation measured by bedside real-time ultrasound for prediction of fluid responsiveness: a Meta-analysis. Zhonghua Wei Zhong Bing Ji Jiu Yi Xue 2020; 32: 99-105. (Chinese)
Kim JH, Kim WY, Oh J, Kang H, Lim TH, Ko BS. Association of inferior vena cava diameter ratio measured on computed tomography scans with the outcome of patients with septic shock. Medicine (Baltimore) 2020; 99(43): e22880.
Seif D, Perera P, Mailhot T, Riley D, Mandavia D. Bedside ultrasound in resuscitation and the rapid ultrasound in shock protocol. Crit Care Res Pract 2012; 2012: 503254.