Predicting Volume Responsiveness By Using The End-expiratory Occlusion In Mechanically Ventilated Patients With Septic Shock

Objective:To determine the reliability and feasibility of end-expiratory occlusion（EEO）predicting fuid responsiveness in mechanically ventilated patients with septicshock.Methods:41mechanically ventilated patients with septic shock, considered forvolume expansion, were enrolled in the study. Cardiac index(CI), pulse pressure (PP)wereacquired using pulse-contour derived cardiac index (PiCCO-plus), meanwhile centralvenous pressure(CVP), heart rate and blood pressure were measured at supine, baseline1,during the end-expiratory occlusion test, during passive leg raising, baseline2and aftervolume expansion (250ml saline infused within10min). An increase of CI by15%or moreafter volume expansion was defined as volume responder.Results: In contrast to nonresponders, CI and PP induced by EEO were increasedsignificantly in responders (p<0.05). EEO-ΔCI and EEO-ΔPP were correlated positivelywith VE-ΔCI(r2=0.914, p <0.001; r2=0.75, p<0.001respectively). AUC for EEO-ΔCI,EEO-ΔPP and PLR-ΔCI were0.916(95%CI:0.786~0.979),0.816(95%CI:0.664~0.919)and0.964(95%CI:0.780~1.000) respectively. EEO-ΔCI≥4%predicted fluidresponsiveness with a sensitivity of92%and a specificity of88%. EEO-ΔPP≥4%predicted fluid responsiveness with a sensitivity of88%%and a specificity of81%.PLR-ΔCI≥10%predicted fluid responsiveness with a sensitivity of100%and aspecificity of86%.Conclusions: EEO could serve as a reliable and feasible approach predicting volumeresponsiveness in mechanically ventilated patients with septic shock.