The Value Of SVV In Predicting Fluid Responsiveness Of Elderly Patients With Septic Shock

Objective:So far severe sepsis and septic shock still are one of problems that needed to be solved in medical field,septic shock also is one of diseases that have a heavier condition and a higher mortality rate in the intensive care unit,early diagnosis and recovery treatment timely for patients with septic shock are helpful for clinical outcomes,it can improve their condition and improve the quality of life of patients.Many researches and a large number of clinical practices suggests that conventional static hemodynamic monitoring indicators(such as central venous pressure,etc.)are not in time and accurate in the prediction of liquid responsiveness,and these indicators are questioned and abandoned by people gradually,stroke volume variation is one of functional hemodynamic monitoring index,the clinical application value in prediction of capacity reactivity of SVV is discussed by this paper,especially for the elderly patients with completely controlled mechanical ventilation,SVV can provide some references for clinical diagnosis and treatment of these patients.Method: Retrospectively collected 64 elderly patients with septic shock of our department from October 2015 to February 2017.Volume-loading test was performed,and stroke volume index(SVI)was served as an indicator estimating volume responsiveness.The patients with SVI increased value more than or equal to 10% were served as reaction group,and the patients with SVI increased value less than 10% were served as non-reaction group.Cardiac output(CO),Central venous blood oxygen saturation(Scv O2),Systemic vascular resistance index(SVRI),Stroke volume SV),Stroke volume variation(SVV)and other related parameters of hemodynamics were measured by Flotrac/Vigileo.Study the predictive value of SVV in fluid responsiveness,the sensitivity and specificity of predictive fluid responsiveness of SVV were analysed by receiver operating characteristic(ROC)Cure.Result : Out of 64 patients,40 were positive volume reaction,and 24 were negative volume reaction.There were no statistical difference in HR,MAP,CVP,CO,Scv O2,SVRI,SV before volume-loading test between two groups(P>0.05),but before the test,SVV in reaction group was significantly higher than that in non-reaction group,so there was statistical difference in SVV.And after the test,the HR in two groups decreased significantly,while MAP,CVP,CO,Scv O2,SVRI,SV clearly increased,and there were statistical difference in HR,MAP,CVP,CO,Scv O2,SVRI,SV of two groups.And after the test,SVV in reaction group was significantly lower than before,and compared with that in non-reaction group,there was also statistical difference in SVV.The area under the Roc cure(Auc)for stroke volume variation(SVV)was 0.875,(95%CI:0.801~0.972).Using SVV≥12% as the threshold to predict fluid responsiveness,the sensitivity was89.1% and specificity was 90.0%.Conclusion:In the intensive care unit,there are some elderly patients with septic shock who recepted fully controlled mechanical ventilation.It is particularly urgent and important that early goal-directed therapy are performed on such patients.Compared with the conventional hemodynamic monitoring index,stroke volume variation can better predict fluid responsiveness in patients with reactive recovery treatment capacity,SVV can guide the liqiud management more timely and effective,secure and reliable than other index,to a certain extent,the hypoperfusion or tissue edema caused by the rehydration too much can be avoided effectively,and the life quality of patients and family members′satisfaction with the treatment are greatly improved,it has higher clinical value,SVV are appreciated and promoted increasingly in medical field.As one of the effective indicators of hemodynamic monitoring,SVV can be combined with other traditional monitoring indicators to determine the change in patients’ condition and guide the therapy dynamically.