The Clinical Study Of Evaluating And Predicting Fluid Responsiveness In Sepsis-induced Cardiac Dysfunction

Objective:This study aims to observe the hemodynamic characteristics and fluid responsiveness of patients with sepsis-induced cardiac systolic dysfunction, and investigate the clinical application value of central venous pressure(CVP) and global end-diastolic volume index(GEDVI) for evaluate and predict fluid responsiveness in patients with sepsis-induced cardiac systolic dysfunction. Method: A prospective, single-centre study was performed in the mixed intensive care unit of Affiliated Drum Tower Hospital of Nanjing University Medical School. From April 2013 to April 2014, a total of 30 patients with sepsis were included. A 90 min crystalloid fluid resuscitation protocol was performed. Hemodynamic parameters were assessed by Pulse-induced contour cardiac output(PiCCO), such as heart rate(HR), mean arterial pressure(MAP), CVP, cardiac output index(CI), left ventricular stroke work index(LVSWI), global ejection fraction(GEF), cardiac function index(CFI), stroke volume index(SVI), left ventricular systolic force index(dPmx), GEDVI, extravascular lung water index(EVLWI) at prior to and after fluid resuscitation. In the process of 90 min fluid resuscitation, measure hemodynamic parameters as above every 30 min. Patients were classified into cardiac systolic dysfunction group (GEF<20% group) and normal cardiac systolic function group (GEF≥20% group) according to GEF. Hemodynamic parameters were compared at prior to and after fluid resuscitation for two groups. Baseline and changes in CVP and GEDVI were compared among responding(CI>10%) and non-responding fluid resuscitation steps(every 30 min) for two groups at baseline. Results:There are 30 sepsis patients and 90 fluid resuscitation steps. The patients with sepsis-induced cardiac systolic dysfunction were 17 cases, the incidence was 56.7%. The baseline of MAP, CI, CVP and GEDVI in two groups showed no significant difference, P>0.05. Other indicators in cardiac systolic dysfunction group, such as LVSWI、CFI and dPmx, were smaller than normal cardiac systolic function group, P<0.05; and the value of GEF、LVSWI、CFI and dPmx had no significant change at prior to and after fluid resuscitation, while the MAP、CI、CVP and GEDVI at after fluid resuscitation were higher, P<0.05. Of 30 sepsis patients, there were 76.5% patients had fluid responsiveness in cardiac systolic dysfunction group, and 61.5% in normal cardiac systolic function group. The incidence was similar, P> 0.05.In cardiac systolic dysfunction group, prior to fluid resuscitation, CVP0 and ΔCVP did not differ between responding and non-responding subgroups; GEDVI0 and ΔGEDVI were higher in responding than non-responding subgroups, P<0.05. In normal cardiac systolic function group, CVP0 did not differ between responding and non-responding subgroups, and levels attained were higher in the latter, P<0.05; GEDVI0 did not differ between responding and non-responding subgroups, P>0.05, ΔGEDVI were higher in responding than non-responding subgroups, P<0.05. Increases in GEDVI were associated with increases in CI in two groups, P<0.05. Conclusions:As estimated from PiCCO, about half of patients with sepsis have cardiac systolic dysfunction. Patients with sepsis-induced cardiac systolic dysfunction may have fluid responsiveness. GEDVI is a good indicator for evaluating fluid responsiveness, and require higher GEDVI in patients with sepsis-induced cardiac systolic dysfunction.