Document Detail

Applying dynamic parameters to predict hemodynamic response to volume expansion in spontaneously breathing patients with septic shock.
MedLine Citation:
PMID:  23324885     Owner:  NLM     Status:  MEDLINE    
Volume expansion is a mainstay of therapy in septic shock, although its effect is difficult to predict using conventional measurements. Dynamic parameters, which vary with respiratory changes, appear to predict hemodynamic response to fluid challenge in mechanically ventilated, paralyzed patients. Whether they predict response in patients who are free from mechanical ventilation is unknown. We hypothesized that dynamic parameters would be predictive in patients not receiving mechanical ventilation. This is a prospective, observational, pilot study. Patients with early septic shock and who were not receiving mechanical ventilation received 10-mL/kg volume expansion (VE) at their treating physician's discretion after initial resuscitation in the emergency department. We used transthoracic echocardiography to measure vena cava collapsibility index and aortic velocity variation before VE. We used a pulse contour analysis device to measure stroke volume variation (SVV). Cardiac index was measured immediately before and after VE using transthoracic echocardiography. Hemodynamic response was defined as an increase in cardiac index 15% or greater. Fourteen patients received VE, five of whom demonstrated a hemodynamic response. Vena cava collapsibility index and SVV were predictive (area under the curve = 0.83, 0.92, respectively). Optimal thresholds were calculated: vena cava collapsibility index, 15% or greater (positive predictive value, 62%; negative predictive value, 100%; P = 0.03); SVV, 17% or greater (positive predictive value 100%, negative predictive value 82%, P = 0.03). Aortic velocity variation was not predictive. Vena cava collapsibility index and SVV predict hemodynamic response to fluid challenge patients with septic shock who are not mechanically ventilated. Optimal thresholds differ from those described in mechanically ventilated patients.
Michael J Lanspa; Colin K Grissom; Eliotte L Hirshberg; Jason P Jones; Samuel M Brown
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Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Shock (Augusta, Ga.)     Volume:  39     ISSN:  1540-0514     ISO Abbreviation:  Shock     Publication Date:  2013 Feb 
Date Detail:
Created Date:  2013-01-17     Completed Date:  2013-06-07     Revised Date:  2014-02-04    
Medline Journal Info:
Nlm Unique ID:  9421564     Medline TA:  Shock     Country:  United States    
Other Details:
Languages:  eng     Pagination:  155-60     Citation Subset:  IM    
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MeSH Terms
Aortic Valve / physiology
Blood Volume / physiology
Fluid Therapy / methods*
Hemodynamics / drug effects*
Intensive Care / methods
Middle Aged
Pilot Projects
Plasma Substitutes / therapeutic use*
Prospective Studies
Shock, Septic / therapy*
Stroke Volume / physiology
Vasodilator Agents / therapeutic use
Grant Support
Reg. No./Substance:
0/Plasma Substitutes; 0/Vasodilator Agents
Comment In:
Shock. 2013 May;39(5):461-2   [PMID:  23591561 ]
Shock. 2013 May;39(5):462   [PMID:  23591562 ]

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