- Poster presentation
- Open Access
Stroke volume variation guided fluid therapy in septic shock with ARDS
Critical Care volume 16, Article number: P233 (2012)
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].
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.
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.
SVV guided fluid therapy in septic shock with ARDS may improve shock by optimizing preload in a targeted way without worsening oxygenation.
Intensive Care Med. 2011, 37: 233-240. 10.1007/s00134-010-2098-8
Crit Care Med. 2008, 36: 2810-2816. 10.1097/CCM.0b013e318186b74e
About this article
Cite this article
Jog, S., Patel, D., Patel, M. et al. Stroke volume variation guided fluid therapy in septic shock with ARDS. Crit Care 16, P233 (2012). https://doi.org/10.1186/cc10840
- Septic Shock
- Central Venous Pressure
- Continuous Renal Replacement Therapy
- Fluid Resuscitation
- Septic Shock Patient