Garg Manjri, Sen Jyotsna, Goyal Sandeep, Chaudhry Dhruva
Department of Medicine, Pt. B.D. Sharma University of Health Sciences, Rohtak, Haryana, India.
Department of Radiodiagnosis, Pt. B.D. Sharma University of Health Sciences, Rohtak, Haryana, India.
Indian J Crit Care Med. 2016 Dec;20(12):708-713. doi: 10.4103/0972-5229.195706.
Fluid infusion, the most critical step in the resuscitation of patients with septic shock, needs preferably continuous invasive hemodynamic monitoring. The study was planned to evaluate the efficacy of ultrasonographically measured inferior vena cava collapsibility index (IVC CI) in comparison to central venous pressure (CVP) in predicting fluid responsiveness in septic shock.
Thirty-six patients of septic shock requiring ventilatory support (invasive/noninvasive) were included. Patients with congestive heart failure, raised intra-abdominal pressure, and poor echo window were excluded from the study. They were randomly divided into two groups based on mode of fluid resuscitation - Group I (CVP) and Group II (IVC CI). Primary end-points were mean arterial pressure (MAP) of ≥65 mmHg and CVP >12 mmHg or IVC CI <20% in Groups I and II, respectively. Patients were followed till achievement of end-points or maximum of 6 h. Outcome variables (pulse rate, MAP, urine output, pH, base deficit, and ScvO ) were serially measured till the end of the study. Survival at 2 and 4 weeks was used as secondary end-point.
Primary end-point was reached in 31 patients (15 in Group I and 16 in Group II). Fluid infusion, by either method, had increased CVP and decreased IVC CI with resultant negative correlation between them (Pearson correlation coefficient -0.626). There was no significant difference in the amount of fluid infused and time to reach end-point in two groups. Comparison in outcome variables at baseline and end-point showed no significant difference including mortality.
CVP and IVC CI are negatively correlated with fluid resuscitation, and both methods can be used for resuscitation, with IVC CI being noninferior to CVP.
液体输注是感染性休克患者复苏中最关键的步骤,最好需要连续有创血流动力学监测。本研究旨在评估超声测量的下腔静脉塌陷指数(IVC CI)与中心静脉压(CVP)相比,在预测感染性休克患者液体反应性方面的有效性。
纳入36例需要通气支持(有创/无创)的感染性休克患者。排除充血性心力衰竭、腹腔内压升高和超声窗不佳的患者。根据液体复苏方式将他们随机分为两组——I组(CVP)和II组(IVC CI)。I组和II组的主要终点分别为平均动脉压(MAP)≥65 mmHg且CVP>12 mmHg或IVC CI<20%。对患者进行随访,直至达到终点或最长6小时。在研究结束前连续测量结果变量(脉搏率、MAP、尿量、pH值、碱缺失和ScvO)。将2周和4周时的生存率作为次要终点。
31例患者达到主要终点(I组15例,II组16例)。无论采用哪种方法进行液体输注,CVP均升高,IVC CI均降低,两者呈负相关(Pearson相关系数-0.626)。两组在输注液体量和达到终点的时间方面无显著差异。基线和终点时结果变量的比较,包括死亡率,均无显著差异。
CVP和IVC CI与液体复苏呈负相关,两种方法均可用于复苏,IVC CI不劣于CVP。