Stroke Volume Variation and Intrathoracic Blood Volume Index as Indicator of Fluid Responsiveness in Mechanically Ventilated Septic Shock Patients with Spontaneous Breathing_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

XuYonghao , HeWeiqun , XuYuanda , SangLing , NongLingbo ,  LiuXiaoqing

The Department of Critical Care Medicine, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou Institute of Respiratory Disease, Guangzhou, Guangdong, 510120, China;

Corresponding author：

LiuXiaoqing, Email: lxq1118@126.com

Keywords：

Septic shock; Stroke volume variation; Intrathoracic blood volume index; Fluid responsiveness

DOI：

10.7507/1671-6205.2015086

Video：

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Objective To evaluate the value of stroke volume variation (SVV) and intrathoracic blood volume index (ITBVI) to predict fluid responsiveness in mechanically ventilated septic shock patients with spontaneous breathing. Methods A prospective observational study was conducted in the Department of Critical Care Medicine of the First Affiliated Hospital of Guangzhou Medical University. Fluid resuscitation data was collected in septic shock patients who received PiCCO monitoring from June 2013 to June 2014. Transpulmonary thermodilution data were collected before and after fluid resuscitation, including cardiac index (CI), SVV, ITBVI, and central venous pressure (CVP). Seventeen patients were defined as responders by an observed increase of≥15% in the cardiac index (CI) after fluid resuscitation, 12 patients were defined as non-responders. Pearson correlation between changes of CI (ΔCI) and SVV, ITBVI, CVP was established. Area under the receiver operating characteristic (ROC) curve of SVV, ITBVI and CVP was calculated for predicting fluid responsiveness. Results Baseline CI and ITBVI were significantly lower in the responders (P < 0.05).There was no significant difference in baseline SVV between the responders and the non-responders (P > 0.05). A significant correlation was found between baseline ITBVI andΔCI (r=-0.593, P < 0.001), but no significant correlation between SVV andΔCI (r=0.037, P=0.847) or CVP andΔCI (r=0.198, P=0.302). The area under ROC curve of SVV, ITBVI and SVV for predicting fluid responsiveness was 0.640 (P=0.207), 0.865 (P=0.001), and 0.463 (P=0.565), respectively. The cut-off value of ITBVI for predicting fluid responsiveness was 784 mL/m² with a sensitivity of 100.0% and a specificity of 70.6%. Conclusion In mechanically ventilated septic shock patients with spontaneous breathing, ITBVI may be a valuable indicator in predicting fluid responsiveness compared with SVV.

Citation： XuYonghao, HeWeiqun, XuYuanda, SangLing, NongLingbo, LiuXiaoqing. Stroke Volume Variation and Intrathoracic Blood Volume Index as Indicator of Fluid Responsiveness in Mechanically Ventilated Septic Shock Patients with Spontaneous Breathing. Chinese Journal of Respiratory and Critical Care Medicine, 2015, 14(4): 345-349. doi: 10.7507/1671-6205.2015086 Copy

1.	Boyd JH, Forbes J, Nakada TA, et al. Fluid resuscitation in septic shock:a positive fluid balance and elevated central venous pressure are associated with increased mortality. Crit Care Med, 2011, 39:259-265.
2.	Murphy CV, Schramm GE, Doherty JA, et al. The importance of fluid management in acute lung injury secondary to septic shock. Chest, 2009, 136:102-109.
3.	Berkenstadt H, Margalit N, Hadani M, et al. Stroke volume variation as a predictor of fluid responsiveness in patients undergoing brain surgery. Anesth Analg, 2001, 92:984-989.
4.	Hofer CK, Muller SM, Furrer L, et al. Stroke volume and pulse pressure variation for prediction of fluid responsiveness in patients undergoing off-pump coronary artery bypass grafting. Chest, 2005, 128:848-854.
5.	Fischer MO, Pelissier A, Bohadana D, et al. Prediction of responsiveness to an intravenous fluid challenge in patients after cardiac surgery with cardiopulmonary bypass:a comparison between arterial pulse pressure variation and digital plethysmographic variability index. J Cardiothorac Vasc Anesth, 2013, 27:1087-1093.
6.	Perner A, Faber T. Stroke volume variation does not predict fluid responsiveness in patients with septic shock on pressure support ventilation. Acta Anaesthesiol Scand, 2006, 50:1068-1073.
7.	Wiesenack C, Prasser C, Rodig G, et al. Stroke volume variation as an indicator of fluid responsiveness using pulse contour analysis in mechanically ventilated patients. Anesth Analg, 2003, 96:1254-1257.
8.	Muller L, Louart G, Bengler C, et al. The intrathoracic blood volume index as an indicator of fluid responsiveness in critically ill patients with acute circulatory failure:a comparison with central venous pressure. Anesth Analg, 2008, 107:607-613.
9.	Tomicic V, Graf J, Echevarria G, et al. Intrathoracic blood volume versus pulmonary artery occlusion pressure as estimators of cardiac preload in critically ill patients. Rev Med Chil, 2005, 133:625-631.
10.	Dellinger RP, Levy MM, Rhodes A, et al. Surviving Sepsis Campaign:international guidelines for management of severe sepsis and septic shock, 2012. Crit Care Med, 2013, 41:580-637.
11.	National Heart Lung and Blood Institute Acute Respiratory Distress Syndrome(ARDS) Clinical Trials Network. Comparison of two fluid management strategies in acute lung injury. N Engl J Med, 2006, 354:2564-2575.
12.	徐静媛, 刘玲, 邱海波.液体复苏对感染性休克患者继发肺水肿的影响.国际麻醉学与复苏杂志, 2011, 32:198-200.
13.	De Backer D, Heenen S, Piagnerelli M, et al. Pulse pressure variations to predict fluid responsiveness:influence of tidal volume. Intensive Care Med, 2005, 31:517-523.
14.	De Backer D, Taccone FS, Holsten R, et al. Influence of respiratory rate on stroke volume variation in mechanically ventilated patients. Anesthesiology, 2009, 110:1092-1097.
15.	Vallee F, Richard JC, Mari A, et al. Pulse pressure variations adjusted by alveolar driving pressure to assess fluid responsiveness. Intensive Care Med, 2009, 35:1004-1010.
16.	Muller L, Louart G, Bousquet PJ, et al. The influence of the airway driving pressure on pulse pressure variation as a predictor of fluid responsiveness. Intensive Care Med, 2010, 36:496-503.
17.	Huang CC, Fu JY, Hu HC, et al. Prediction of fluid responsiveness in acute respiratory distress syndrome patients ventilated with low tidal volume and high positive end-expiratory pressure. Crit Care Med, 2008, 36:2810-2816.
18.	Lakhal K, Ehrmann S, Benzekri-Lefevre D, et al. Respiratory pulse pressure variation fails to predict fluid responsiveness in acute respiratory distress syndrome. Crit Care, 2011, 15:R85.
19.	徐永昊, 刘晓青, 何为群, 等.胸腔内血容量指数在感染性休克患者液体管理中的应用.中国危重病急救医学, 2011, 23:462-466.
20.	Trof RJ, Danad I, Reilingh MW, et al. Cardiac filling volumes versus pressures for predicting fluid responsiveness after cardiovascular surgery:the role of systolic cardiac function. Crit Care, 2011, 15:R73.

1. Boyd JH, Forbes J, Nakada TA, et al. Fluid resuscitation in septic shock:a positive fluid balance and elevated central venous pressure are associated with increased mortality. Crit Care Med, 2011, 39:259-265.
2. Murphy CV, Schramm GE, Doherty JA, et al. The importance of fluid management in acute lung injury secondary to septic shock. Chest, 2009, 136:102-109.
3. Berkenstadt H, Margalit N, Hadani M, et al. Stroke volume variation as a predictor of fluid responsiveness in patients undergoing brain surgery. Anesth Analg, 2001, 92:984-989.
4. Hofer CK, Muller SM, Furrer L, et al. Stroke volume and pulse pressure variation for prediction of fluid responsiveness in patients undergoing off-pump coronary artery bypass grafting. Chest, 2005, 128:848-854.
5. Fischer MO, Pelissier A, Bohadana D, et al. Prediction of responsiveness to an intravenous fluid challenge in patients after cardiac surgery with cardiopulmonary bypass:a comparison between arterial pulse pressure variation and digital plethysmographic variability index. J Cardiothorac Vasc Anesth, 2013, 27:1087-1093.
6. Perner A, Faber T. Stroke volume variation does not predict fluid responsiveness in patients with septic shock on pressure support ventilation. Acta Anaesthesiol Scand, 2006, 50:1068-1073.
7. Wiesenack C, Prasser C, Rodig G, et al. Stroke volume variation as an indicator of fluid responsiveness using pulse contour analysis in mechanically ventilated patients. Anesth Analg, 2003, 96:1254-1257.
8. Muller L, Louart G, Bengler C, et al. The intrathoracic blood volume index as an indicator of fluid responsiveness in critically ill patients with acute circulatory failure:a comparison with central venous pressure. Anesth Analg, 2008, 107:607-613.
9. Tomicic V, Graf J, Echevarria G, et al. Intrathoracic blood volume versus pulmonary artery occlusion pressure as estimators of cardiac preload in critically ill patients. Rev Med Chil, 2005, 133:625-631.
10. Dellinger RP, Levy MM, Rhodes A, et al. Surviving Sepsis Campaign:international guidelines for management of severe sepsis and septic shock, 2012. Crit Care Med, 2013, 41:580-637.
11. National Heart Lung and Blood Institute Acute Respiratory Distress Syndrome(ARDS) Clinical Trials Network. Comparison of two fluid management strategies in acute lung injury. N Engl J Med, 2006, 354:2564-2575.
12. 徐静媛, 刘玲, 邱海波.液体复苏对感染性休克患者继发肺水肿的影响.国际麻醉学与复苏杂志, 2011, 32:198-200.
13. De Backer D, Heenen S, Piagnerelli M, et al. Pulse pressure variations to predict fluid responsiveness:influence of tidal volume. Intensive Care Med, 2005, 31:517-523.
14. De Backer D, Taccone FS, Holsten R, et al. Influence of respiratory rate on stroke volume variation in mechanically ventilated patients. Anesthesiology, 2009, 110:1092-1097.
15. Vallee F, Richard JC, Mari A, et al. Pulse pressure variations adjusted by alveolar driving pressure to assess fluid responsiveness. Intensive Care Med, 2009, 35:1004-1010.
16. Muller L, Louart G, Bousquet PJ, et al. The influence of the airway driving pressure on pulse pressure variation as a predictor of fluid responsiveness. Intensive Care Med, 2010, 36:496-503.
17. Huang CC, Fu JY, Hu HC, et al. Prediction of fluid responsiveness in acute respiratory distress syndrome patients ventilated with low tidal volume and high positive end-expiratory pressure. Crit Care Med, 2008, 36:2810-2816.
18. Lakhal K, Ehrmann S, Benzekri-Lefevre D, et al. Respiratory pulse pressure variation fails to predict fluid responsiveness in acute respiratory distress syndrome. Crit Care, 2011, 15:R85.
19. 徐永昊, 刘晓青, 何为群, 等.胸腔内血容量指数在感染性休克患者液体管理中的应用.中国危重病急救医学, 2011, 23:462-466.
20. Trof RJ, Danad I, Reilingh MW, et al. Cardiac filling volumes versus pressures for predicting fluid responsiveness after cardiovascular surgery:the role of systolic cardiac function. Crit Care, 2011, 15:R73.

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Stroke Volume Variation and Intrathoracic Blood Volume Index as Indicator of Fluid Responsiveness in Mechanically Ventilated Septic Shock Patients with Spontaneous Breathing

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