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

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.

Download Full-text

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

Critical Care Medicine ◽

10.1097/00003246-200512002-00589 ◽

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

Download Full-text

Echocardiography for left ventricular outflow tract velocity time integral versus inferior vena cava collapsibility index as a predictor to fluid responsiveness in severe sepsis

QJM ◽

10.1093/qjmed/hcaa039.032 ◽

2020 ◽

Vol 113 (Supplement_1) ◽

Author(s):

D A M Nasr ◽

A A Moharam ◽

M M K Abdallah ◽

A A S M Karam

Keyword(s):

Septic Shock ◽

Severe Sepsis ◽

Fluid Responsiveness ◽

Host Response ◽

Vena Cava ◽

Ventricular Outflow Tract ◽

Left Ventricular ◽

Collapsibility Index ◽

Left Ventricular Outflow ◽

Sepsis And Septic Shock

Abstract Background Severe sepsis is the most common cause of death for patients admitted to the critical care units. Sepsis is a multifaceted host response to an infecting pathogen that may be significantly amplified by endogenous factors. Sepsis is defined as life-threatening organ dysfunction caused by a dysregulated host response to infection. This emphasizes the primacy of the non-homeostatic host-response to infection, the potential lethality that is considerably in excess of a straightforward infection, and the need for urgent recognition. Aims The aim of this work is to compare Left ventricular Outflow Tract (LVOT) velocity time Integral (VTI) and inferior Vena Cava (IVC) collapsibility index as a predictor to fluid responsiveness in patients with severe sepsis and septic shock. Methodology This study was conducted on 40 patients of both sex who were admitted to the intensive care unit were diagnosed as severe sepsis and /or septic shock. Patients were divided in two groups: Responders (R): 22 patients with LVOT ΔVTI 500 ≥ 15%. Non-responders (NR): 18 patients with LVOT ΔVTI 500 < 15%. Results Our results showed that IVCCI 100 and 500 were a less reliable predictor to fluid responsiveness in patients with severe sepsis and septic shock than ΔVTI 500. However when using IVCCI after 100 or 500 cc of fluid resuscitation, patients with IVCCI 100 above 38% or IVCCI 500 above 30% are more likely to respond to fluid challenge. More precisely, an IVCCI 100 below 38% and IVCCI 500 value below 30% cannot exclude fluid responsiveness. Conclusions IVC collapsibility Index is less reliable predictor than VTI (LVOT) in predicting fluid responsiveness in spontaneously breathing patients diagnosed with severe sepsis and/ or septic shock Recommendations IVCCI should be used more cautiously as a predictor to fluid responsiveness in spontaneously breathing patients diagnosed with severe sepsis and /or septic shock.

Download Full-text

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

Srpski arhiv za celokupno lekarstvo ◽

10.2298/sarh0806248j ◽

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.

Download Full-text