Monitoring of intrathoracic blood volume in early septic patients: its correlation with survival

Introduction

Early goal directed therapy improves survival in sepsis, trough optimisation of contractility, oxygen balance and correction of fluids deficit [1]. Aim of the study is to investigate whether optimisation of ITBV (intrathoracic blood volume) an index of preload, could be a therapeutic end point in early sepsis, as previously demonstrated in burns patients [2].

Methods

Sixty septic patients (Bone criteria) were monitored with a central vein catheter and an artery femoral catheter connected to a fiberoptic system (Cold Z-02; Pulsion Medizintechnic) Patients were submitted to a fluid management protocol to obtain MAP = 75 mm/Hg, maintaining ITBVI 800-1000 ml/m² and EVLWI <7.5 ml/kg. At T0 (basal) and after 24 (T1), 48 (T2) 72 (T3) and 96 hours (T4) main volumetric, hemodynamic data were studied. ANOVA test was used to compare changes over time. A Fisher test was used to compare categorical data.

Results

Thirty-two patients survived (Group A) and 28 died at 28 days (Group B). ITBVI was higher in Group A than Group B at T1 and T2 (Fig. 1). And ITBVI > 800 ml/m² at T1 and T2 was predictive of survival.

Figure 1

Comment

(1) ITBVI improves earlier in survivors then non survivors during a reanimation period. (2) This improvement has a predictive value. (3) Optimisation of ITBVI during early sepsis should be evaluated in further trials.

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