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Stroke volume variation guided fluid therapy in septic shock with ARDS

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

Conclusion

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

References

  1. 1.

    Intensive Care Med. 2011, 37: 233-240. 10.1007/s00134-010-2098-8

  2. 2.

    Crit Care Med. 2008, 36: 2810-2816. 10.1097/CCM.0b013e318186b74e

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Author information

Correspondence to S Jog.

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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

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Keywords

  • Septic Shock
  • Central Venous Pressure
  • Continuous Renal Replacement Therapy
  • Fluid Resuscitation
  • Septic Shock Patient