Hemodynamic effects of different fluid volumes for a fluid challenge in septic shock patients

作     者：Ting Yang Li Weng Wei Jiang Shan Li Bin Du Ting Yang;Li Weng;Wei Jiang;Shan Li;Bin Du

作者机构：Medical Intensive Care UnitState Key Laboratory of Complex Severe and Rare DiseasesPeking Union Medical College HospitalPeking Union Medical CollegeChinese Academy of Medical SciencesBeijing 100730China 

出 版 物：《Chinese Medical Journal》 (中华医学杂志（英文版）)

年 卷 期：2022年第135卷第6期

页      面：672-680页

核心收录：

学科分类：100218[医学-急诊医学] 1002[医学-临床医学] 10[医学] 

基　　金：supported by grants from the Ministry of Science and Technology of People Republic of China(No.2020YFC0841300) Beijing Municipal Science and technology commission(No.Z201100005520037)。 

主　　题：Cardiac output(CO) Fluid challenge(FC) Arterial load Effective arterial elastance(Ea) Septic shock 

摘      要：Background:It is still unclear what the minimal infusion volume is to effectively predict fluid responsiveness.This study was designed to explore the minimal infusion volume to effectively predict fluid responsiveness in septic shock patients.Hemodynamic effects of fluid administration on arterial load were observed and added values of effective arterial elastance(Ea)in fluid resuscitation were assessed.Methods:Intensive care unit septic shock patients with indwelling pulmonary artery catheter(PAC)received five sequential intravenous boluses of 100 mL 4%gelatin.Cardiac output(CO)was measured with PAC before and after each bolus.Fluid responsiveness was defined as an increase in CO10%after 500 mL fluid infusion.Results:Forty-seven patients were included and 35(74.5%)patients were fluid responders.CO increasing5.2%after a 200 mL fluid challenge(FC)provided an improved detection of fluid responsiveness,with a specificity of 80.0%and a sensitivity of 91.7%.The area under the ROC curve(AUC)was 0.93(95%CI:0.84-1.00,P0.001).Fluid administration induced a decrease in Ea from 2.23(1.46-2.78)mmHg/mL to 1.83(1.34-2.44)mmHg/mL(P=0.002),especially for fluid responders in whom arterial pressure did not increase.Notably,the baseline Ea was able to detect the fluid responsiveness with an AUC of 0.74(95%CI:0.59-0.86,P0.001),whereas Ea failed to predict the pressure response to FC with an AUC of 0.50(95%CI:0.33-0.67,P=0.086).Conclusion:In septic shock patients,a minimal volume of 200 mL 4%gelatin could reliably detect fluid responders.Fluid administration reduced Ea even when CO increased.The loss of arterial load might be the reason for patients who increased their CO without pressure responsiveness.Moreover,a high level of Ea before FC was able to predict fluid responsiveness rather than to detect the pressure responsiveness.