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Open Access

Stroke volume variation guided fluid therapy in septic shock with ARDS

  • S Jog1,
  • D Patel1,
  • M Patel1 and
  • S Sable1
Critical Care201216(Suppl 1):P233

https://doi.org/10.1186/cc10840

Published: 20 March 2012

Keywords

Septic ShockCentral Venous PressureContinuous Renal Replacement TherapyFluid ResuscitationSeptic Shock Patient

Introduction

Optimal fluid resuscitation guided by central venous pressure (CVP) in patients having septic shock with ARDS is a perplexed issue having risk of underfilling and worsening of shock versus fluid overload leading to pulmonary edema. Whether stroke volume variation (SVV) (Flotrac-Vigileo system) guided fluid resuscitation has an impact on improvement of shock, oxygenation and mortality were tested in this single-center prospective study [1, 2].

Methods

Inclusion criteria were: (1) septic shock patients with dose of norepinephrine ≥0.1 μg/kg/minute or dopamine ≥10 μg/kg/minute; (2) CVP ≥12 mmHg; (3) PO2/FiO2 ratio ≤200 with ARDSnet protocol ventilation under deep sedation. Exclusion criteria were atrial/ventricular arrhythmias, spontaneous triggering of inspiration, established renal failure needing continuous renal replacement therapy (CRRT). During the 24-hour study period, SVV was continuously monitored with the third-generation Flotrac-Vigileo system (version 3.02). Intravenous fluids were given in the boluses of 250 to 500 cm3 to keep SVV <12% throughout the study period. Vasopressor infusion was titrated to keep MAP >70 mmHg.

Results

Thirty-seven patients with severe sepsis-induced multiorgan dysfunction syndrome with average APACHE II score of 24.6 and PEEP of 8.2 cm were enrolled. SVV guided fluids received during the 24-hour study period were 5.1 ± 2.6 l. Arterial lactates reduced significantly without worsening of hypoxia. The PO2/FiO2 ratio increased significantly at 24 hours. Twenty-two out of 37 survived (59.45%) until hospital discharge. See Table 1.
Table 1

Hemodynamic variables at 0 and 24 hours

Variable

0 hours

24 hours

P value

CVP

15.51

16.2

>0.1

MAP

73.6

76.4

>0.1

SVV%

13.61

10.8

>0.1

Arterial lactate

3.9 ± 2.6

2.3 ± 1.5

<0.001

PO2/FiO2

120.6 ± 42

193.4 ± 76

<0.001

Conclusion

SVV guided fluid therapy in septic shock with ARDS may improve shock by optimizing preload in a targeted way without worsening oxygenation.

Authors’ Affiliations

(1)
Deenanath Mangeshkar Hospital and Research Centre, Pune, India

References

  1. Intensive Care Med. 2011, 37: 233-240. 10.1007/s00134-010-2098-8Google Scholar
  2. Crit Care Med. 2008, 36: 2810-2816. 10.1097/CCM.0b013e318186b74eGoogle Scholar

Copyright

© Jog et al.; licensee BioMed Central Ltd. 2012

This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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