Oord Martha, Olgers Tycho J, Doff-Holman Mirjam, Harms Mark P M, Ligtenberg Jack J M, Ter Maaten Jan C
Department of Internal Medicine, University Groningen, University Medical Center Groningen, Groningen, The Netherlands.
BMJ Open. 2017 Jan 27;7(1):e013465. doi: 10.1136/bmjopen-2016-013465.
We investigated whether combining the caval index, assessment of the global contractility of the heart and measurement of stroke volume with Noninvasive Cardiac Output Monitoring (NICOM) can aid in fluid management in the emergency department (ED) in patients with sepsis.
A prospective observational single-centre pilot study in a tertiary care centre.
Ultrasound was used to assess the caval index, heart contractility and presence of B-lines in the lungs. Cardiac output and stroke volume were monitored with NICOM. Primary outcome was increase in stroke volume after a fluid bolus of 500 mL, while secondary outcome included signs of fluid overload.
We included 37 patients with sepsis who received fluid resuscitation of at least 500 mL saline. The population was divided into patients with a high (>36.5%, n=24) and a low caval index (<36.5%, n=13). We observed a significant increase (p=0.022) in stroke volume after 1000 mL fluid in the high caval index group in contrast to the low caval index group but not after 500 mL of fluid. We did not find a significant association between global contractility of the left ventricle and the response on fluid therapy (p=0.086). No patient showed signs of fluid overload.
Our small pilot study suggests that at least 1000 mL saline is needed to induce a significant response in stroke volume in patients with sepsis and a high caval index. This amount seems to be safe, not leading to the development of fluid overload. Therefore, combining ultrasound and NICOM is feasible and may be valuable tools in the treatment of patients with sepsis in the ED. A larger trial is needed to confirm these results.
我们研究了将腔静脉指数、心脏整体收缩功能评估以及通过无创心输出量监测（NICOM）测量每搏输出量相结合，是否有助于脓毒症患者在急诊科（ED）的液体管理。
在一家三级医疗中心进行的前瞻性观察性单中心试点研究。
使用超声评估腔静脉指数、心脏收缩功能以及肺部B线的存在情况。通过NICOM监测心输出量和每搏输出量。主要结局是给予500 mL液体冲击后每搏输出量的增加，次要结局包括液体过载的体征。
我们纳入了37例接受至少500 mL生理盐水液体复苏的脓毒症患者。将研究人群分为腔静脉指数高（>36.5%，n = 24）和腔静脉指数低（<36.5%，n = 13）的患者。与腔静脉指数低的组相比，我们观察到腔静脉指数高的组在给予1000 mL液体后每搏输出量有显著增加（p = 0.022），但给予500 mL液体后没有。我们未发现左心室整体收缩功能与液体治疗反应之间存在显著关联（p = 0.086）。没有患者出现液体过载的体征。
我们的小型试点研究表明，对于脓毒症且腔静脉指数高的患者，至少需要1000 mL生理盐水才能引起每搏输出量的显著反应。这个量似乎是安全的，不会导致液体过载的发生。因此，将超声和NICOM相结合是可行的，并且可能是急诊科治疗脓毒症患者的有价值工具。需要更大规模的试验来证实这些结果。
