OPTIMAL CENTRAL VENOUS PRESSURE IN FLUID CHALLENGE IN SEVERE SEPSIS AND SEPTIC SHOCK.

2005 ◽  
Vol 33 ◽  
pp. A166
Author(s):  
Bogdan N Dobrin ◽  
Giulia Soldati ◽  
Marc Van Nuffelen ◽  
Jean-Louis Vincent
Keyword(s):  
Septic Shock ◽  
Severe Sepsis ◽  
Central Venous Pressure ◽  
Venous Pressure ◽  
Fluid Challenge ◽  
Central Venous ◽  
Sepsis And Septic Shock

scholarly journals New therapy strategies for treatment of severe sepsis and septic shock in Intensive care unit of Clinical centre in Kragujevac

2008 ◽  
Vol 136 (5-6) ◽  
pp. 248-252
Author(s):  
Jasna Jevdjic ◽  
Maja Surbatovic ◽  
Svetlana Drakulic-Miletic ◽  
Vladimir Vukicevic
Keyword(s):  
Septic Shock ◽  
Severe Sepsis ◽  
Central Venous Pressure ◽  
Venous Pressure ◽  
Thrombosis Prophylaxis ◽  
Central Venous ◽  
Vein Thrombosis ◽  
New Therapy ◽  
Sepsis And Septic Shock ◽  
Therapy Strategies

INTRODUCTION Despite numerous advances in medicine, the mortality rate of severe sepsis and septic shock remains high, 30-50%. New therapy strategies include: early goaldirected therapy, fluid replacement, early and appropriate antimicrobials, source of infection control, use of corticosteroids, vasopressors and inotropic therapy, use of recombinant activated protein C, tight glucose control, low-tidal-volume mechanical ventilation. They have been shown to improve the outcomes. The adequacy and speed of treatment influence the outcome, too. OBJECTIVE The objective was to evaluate if new therapy strategies had been integrated in our routine practice. METOD Patients with severe sepsis or septic shock, who were treated in the Intensive Care Unit (ICU) over a ten-month period, were analyzed retrospectively. The descriptive epidemiological method was applied. Central venous catheterization, central venous pressure, antibiotics, fluid resuscitation, mechanical ventilation, vasopressors, corticosteroids, blood administration, deep vein thrombosis prophylaxis, stress ulcer prophylaxis, glucose control, were evaluated. RESULTS 27 patients were analyzed. Patient characteristics were: age, 49.9 years (18-77) with 30-day in-hospital mortality rate of 48.1%. All patients received broad-spectrum antibiotics. Blood cultures were obtained in 85.2% patients. Adequate antimicrobial treatment was applied to 59.3% and 74.1% patients had central venous pressure monitoring. Average central venous pressure was 8.47?5.6 mm Hg (-2- 20). Aggressive fluid therapy was given to 33.3% of the cases and 66.7% of the patients with septic shock received vasoactive drugs while 29.6% received corticosteroids. Red blood cell transfusions were applied in 59.3% of patients. All patients received stress ulcer prophylaxis, and 37% of them deep vein thrombosis prophylaxis. The average value of morning glucose was 9.11?5.03 mmol/l (3.7-22.0). 63% of patients were mechanically ventilated. Blood lactate was not determined. CONCLUSION Evidence-based clinical guidelines for management of severe sepsis and septic shock have not been implemented in a widespread, systematic way in the ICU of the Clinical Centre, Kragujevac. Institutional acceptance of this protocol, and education of clinicians may improve survivability for patients with sepsis.

scholarly journals Exploring the Optimal Range of Central Venous Pressure in Sepsis and Septic Shock Patients: A Retrospective Study in 208 Hospitals

2020 ◽  
Author(s):  
Xiaodong Song ◽  
Zhaoxia Tang ◽  
Shuhe Li ◽  
Jinghong Xu ◽  
Fa Huang ◽  
...  
Keyword(s):  
Septic Shock ◽  
Logistic Regression ◽  
Retrospective Study ◽  
Central Venous Pressure ◽  
Clinical Outcomes ◽  
Venous Pressure ◽  
Hospital Death ◽  
Central Venous ◽  
Death Risk ◽  
Sepsis And Septic Shock

Abstract Background: The appropriate range of central venous pressure (CVP) in sepsis patients remains controversial. The aim of this study was to investigate the optimal CVP range in sepsis and septic shock patients admitted to intensive care unit.Methods: We performed a retrospective study with adult sepsis patients with CVP records based on the eICU Collaborative Research Database. Cases were divided into three groups according to mean CVP level during ICU stay: low (< 8 mmHg), normal (8–12 mmHg), and high (> 12 mmHg). Baseline characteristics and clinical outcomes of three groups were compared. Multivariable logistic regression was used to assess the relationship between different CVP levels (by equal interval of 4 mmHg) and in-hospital death risk. Results: 5302 sepsis patients were included in this study. Lactate level, serum creatinine, proportion of mechanical ventilation and dialysis were significantly higher in high CVP group compared to normal CVP group (2.6 [1.6,3.4] vs 2.2 [1.4,2.9] mmol/L; 1.5 [1,2.4] vs 1.2 [0.8,2] mg/dL; 52.2% vs 48.2%; 14.6% vs 9.7%; p < 0.05, respectively). In addition, high CVP group tended to have higher ICU mortality (24.8% vs 15.9%, p < 0.05) and hospital mortality (32.2% vs 22.4%, p < 0.05). The logistic regression analyses revealed that, in sepsis patients, CVP range of 12-16 mmHg, 16-20 mmHg and > 20 mmHg was related to increased in-hospital death risk compared to 8-12 mmHg level (OR: 1.349, 2.287, 3.210, respectively; 95% CI: 1.161–1.568, 1.897–2.757, 2.403–4.290, respectively); there were no significant differences between 0-4 mmHg, 4-8 mmHg and 8-12 mmHg levels regarding in-hospital death risk. Whereas in septic shock patients, CVP level of 0-4 mmHg, 12-16 mmHg, 16-20 mmHg and > 20 mmHg all contributed to increased in-hospital death risk (OR: 1.914, 1.652, 3.305, 3.554, respectively; 95% CI: 1.165–3.146, 1.299–2.101, 2.444–4.47, 2.233–5.654, respectively).Conclusions: High CVP level (> 12 mmHg) was related to worse clinical outcomes in both sepsis and septic shock patients; while very low CVP level (< 4 mmHg) in septic shock patients was also harmful. More strict fluid administration was essential in septic shock population.

Effect of fluid bolus triggers and their combination on fluid responsiveness in optimization phase of severe sepsis and septic shock resuscitation

MedPharmRes ◽  
2018 ◽  
Vol 2 (3) ◽  
pp. 27-32
Author(s):  
Bien Le ◽  
Dai Huynh ◽  
Mai Tuan ◽  
Minh Phan ◽  
Thao Pham ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Septic Shock ◽  
Severe Sepsis ◽  
Fluid Responsiveness ◽  
Statistical Significance ◽  
Venous Pressure ◽  
Fluid Bolus ◽  
Low Blood Pressure ◽  
Low Central Venous Pressure ◽  
Sepsis And Septic Shock

Objectives: to evaluate the fluid responsiveness according to fluid bolus triggers and their combination in severe sepsis and septic shock. Design: observational study. Patients and Methods: patients with severe sepsis and septic shock who already received fluid after rescue phase of resuscitation. Fluid bolus (FB) was prescribed upon perceived hypovolemic manifestations: low central venous pressure (CVP), low blood pressure, tachycardia, low urine output (UOP), hyperlactatemia. FB was performed by Ringer lactate 500 ml/30 min and responsiveness was defined by increasing in stroke volume (SV) ≥15%. Results: 84 patients were enrolled, among them 30 responded to FB (35.7%). Demographic and hemodynamic profile before fluid bolus were similar between responders and non-responders, except CVP was lower in responders (7.3 ± 3.4 mmHg vs 9.2 ± 3.6 mmHg) (p 0.018). Fluid response in low CVP, low blood pressure, tachycardia, low UOP, hyperlactatemia were 48.6%, 47.4%, 38.5%, 37.0%, 36.8% making the odd ratio (OR) of these triggers were 2.81 (1.09-7.27), 1.60 (0.54-4.78), 1.89 (0.58-6.18), 1.15 (0.41-3.27) and 1.27 (0.46-3.53) respectively. Although CVP < 8 mmHg had a higher response rate, the association was not consistent at lower cut-offs. The combination of these triggers appeared to raise fluid response but did not reach statistical significance: 26.7% (1 trigger), 31.0% (2 triggers), 35.7% (3 triggers), 55.6% (4 triggers), 100% (5 triggers). Conclusions: fluid responsiveness was low in optimization phase of resuscitation. No fluid bolus trigger was superior to the others in term of providing a higher responsiveness, their combination did not improve fluid responsiveness as well.

scholarly journals Respiratory variation of inferior vena cava diameter and central venous pressure in ventilated and non-ventilated children in fluid refractory septic shock: an observational study

2019 ◽  
Vol 6 (5) ◽  
pp. 1947
Author(s):  
Mohd Kashif Ali ◽  
Eeman Naim
Keyword(s):  
Septic Shock ◽  
Inferior Vena Cava ◽  
Central Venous Pressure ◽  
Inferior Vena ◽  
Venous Pressure ◽  
Vena Cava ◽  
Central Venous ◽  
Mechanically Ventilated ◽  
Spontaneously Breathing ◽  
Ventilated Patients

Background: Ultrasound guided fluid assessment in management of septic shock has come up as an adjunct to the current gold standard Central Venous Pressure monitoring. This study was designed to observe the respiro-phasic variation of IVC diameter (RV-IVCD) in invasively mechanically ventilated and spontaneously breathing paediatric patients of fluid refractory septic shock.Methods: This was a prospective observational study done at Paediatric intensive Care Unit (PICU) in Paediatric ward of Jawaharlal Nehru Medical College and Hospital (JNMCH) from February 2016 to June 2017. 107 consecutive patients between 1 year to 16 years age who were in shock despite 40ml/kg of fluid administration were included. Inferior Vena Cava (IVC) diameters were measured at end-expiration and end inspiration and the IVC collapsibility index was calculated. Simultaneously Central Venous Pressure (CVP) was recorded. Both values were obtained in ventilated and non-ventilated patients. Data was analysed to determine to look for the profile of RV-IVCD and CVP in ventilated and non-ventilated cases.Results: Out of 107 patients, 91 were on invasive mechanical ventilation and 16 patients were spontaneously breathing. There was a strong negative correlation between central venous pressure (CVP) and inferior vena cava collapsibility (RV-IVCD) in both spontaneously breathing (-0.810) and mechanically ventilated patients (-0.700). Negative correlation was significant in both study groups in CVP <8 mmHg and only in spontaneously breathing patients in CVP 8-12 mmHg range. IVC collapsibility showed a decreasing trend with rising CVP in both spontaneously breathing and mechanically ventilated patients.Conclusion: Ultrasonography guided IVCCI appears to be a valuable index in assessing fluid status in both spontaneously breathing and mechanically ventilated septic shock patients. However, more data is required from the paediatric population so as to define it as standard of practice.

Diagnostic Validity of Ratio between Differences of Central Venous to Arterial CO2 and Arterial to Central Venous O2 Content in Diagnosis of Anaerobic Metabolism among Septic Patients

2021 ◽  
Vol 8 (1) ◽  
pp. 34-38
Author(s):  
Subroto Kumar Sarker ◽  
Umme Kulsum Choudhury ◽  
Mohammad Mohsin ◽  
Subrata Kumar Mondal ◽  
Muslema Begum
Keyword(s):  
Septic Shock ◽  
Severe Sepsis ◽  
Intensive Care ◽  
Anaerobic Metabolism ◽  
Venous Blood ◽  
Blood Gases ◽  
Serum Lactate ◽  
Central Venous ◽  
College Hospital ◽  
Sepsis And Septic Shock

Background: Detection of anaerobic metabolism is very crucial for the management of the septic patients. Objective: The purpose of the present study was to validate the ratio between differences of central venous to arterial CO2 and arterial to central venous O2 content in diagnosis of anaerobic metabolism among septic patients. Methodology: This prospective observational study was conducted in the Intensive Care Unit of the department of Anaesthesia Analgesia, Palliative and Intensive Care Medicine at Dhaka Medical College Hospital, Dhaka, Bangladesh from January 2016 to December 2016. All patients admitted to ICU with the features of severe sepsis and septic shock according to SSC guidelines with the age of more than or equal to 18 years in both sexes were included in this study. The arterial and central venous blood gases were measure simultaneously. At the same time serum lactate was measured. Result: Among the 69 patients, 31(44.9%) were of severe sepsis and 38(55%) were of septic shock patients. In the severe sepsis and septic shock patients the mean P(v-a)CO2/C(a-v)O2 is 1.39±0.41 and 1.11±0.40 respectively. Serum lactate in case of severe sepsis and septic shock patients is 2.85±1.40 and 3.85±1.04 respectively. The ROC analysis showed an area under curve 0.89 and P(v-a)CO2/C(a-v)O2 ratio cutoff value of 1.21 showed sensitivity 0.84 and specificity 0.94. Conclusion: The P(v-a)CO2/C(a-v)O2  ratio is also a another marker of global anaerobic metabolism and it would be used for diagnosis as well as management of septic patient.  Journal of Current and Advance Medical Research, January 2021;8(1):34-38

A central venous pressure goal of 8–12 mm Hg for all patients in septic shock

2007 ◽  
Vol 35 (5) ◽  
pp. 1441 ◽  
Author(s):  
Michael W. Donnino ◽  
Peter Clardy ◽  
Daniel Talmor
Keyword(s):  
Septic Shock ◽  
Central Venous Pressure ◽  
Venous Pressure ◽  
Central Venous
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