Septic Shock, Early Fluid Responsiveness Indicators Significance

Objective:To assess the role of pressure indicator CVP, volume indicator GEDI and ventricular wall stress indicator BNP in the judgement of fluid challenge in early septic shock.And the relationship of fluid resuscitation and the improvement of tissue perfusion.Methods:septic shock patients were admitted from October 2008 to March 2010 in Beijing Union Medical College Hospital Intensive Care Union department. We give the patients fluid loading test and record the patients' hemodynamic situation as the CVP, GEDI, EVLWI, CO and biochemical indicators of BNP before and after volume expansion. We compare the difference between the fluid responsible group (△CO≥15%) and the fluid unresponsible group (△CO≤15%) of its CVP, GEDI and BNP. Further analysis of the relationship between fluid responsiveness and tissue perfusion.Results:26 patients included in this research,16 pationts are fluid responsible (△CO≥15%), and 10 pationts are fluid unresponsible (△CO≤15%), the initial GEDI has a better linear correlation with CO than the initial CVP, but both GEDI and CVP have no significant difference between fluid responsible group and fluid unresponsible group, while△GEDI is higher in responsible group than unresponsible group,119.5 (90.0-164.0) vs 4.0 (-90-33.5), p<0.05.△CVP doesn't have difference in the two groups,2.0 (1.7-3.2) vs 2.5 (2-5.7) mmHg.The responsible group has a significant higher slope of△GEDI/△CVP curve than the unresponsible group 44.5 (37.0-82.0) vs 0.0 (-3.0-+4.0), p<0.02. The initial BNP in the responsible group is less than the unresponsible group 162 (91.6-372) vs 2130 (1465-3080) pg/dl, p<0.05, there is a good linear correlation between△BNP and cardiac pressure volume curve slope (△GEDI/△CVP),the correlation coefficient is-0.414, p= 0.002. GEDI less than 679ml/ m2 group has higher risk of inadequate tissue perfusion than GEDI than 679ml/m2 group of its. But in the low GEDI group, only the low BNP parts can improve tissue perfusion after fluid resuscitationConclusion:The initial GEDI can reflect the pre-load conditions more accurately than CVP.△GEDI/△CVP reflects the heart's pressure-volume relationship, is an important factor in the decision of fluid response. initial BNP can be used to predict the response to the fluid challenge. GEDI prompted the need for resuscitation, BNP predicted the feasibility of fluid resuscitation, GEDI joint BNP can improve the efficiency of the resuscitation, avoid unnecessary volume loading.