Comparison Of Predicting Fluid Responsiveness Between Ultrasound And Pulse Indicator Continuous Cardiac Output In Elderly Sepsis

Objective Investigate and compare the predictive value of indexes under ultrasound and pulse indicator continuous cardiac output(PiCCO)monitoring for fluid responsiveness in elderly sepsis.Methods 39 sepsis patients aged over 60 years were enrolled from the Intensive Care Unit of Zhejiang hospitals from January 2019 to January 2020.The patients were divided into fluid-responsive(FR)-positive and negative groups based on whether the rate of change in stroke volume(△SV)under PiCCO monitoring before and after the passive leg raising test(PLR)was greater than 12%.Simultaneously monitor and compare the predictive value between stroke volume variability(SVV)monitored by PiCCO with inferior vena cava respiratory variability(△IVC),peak velocity variability of aortic flow(△Vpeak),velocity time integral variability of aortic flow before and after PLR(PLR-△VTI)for FR.Results1.There was no statistical difference between the two groups in general information such as gender,age,body surface area,acute physiology and chronic health evaluation system(APACHE Ⅱ score),and infection site(P>0.05).In cardiac function index values,there was no significant difference in systolic function between the two groups(P>0.05),but the diastolic function was worse in the FR-negative group(P<0.05).Among the hemodynamic indicators at basal position,there was no statistical difference in heart rate(HR),mean arterial pressure(MAP),central venous pressure(CVP),stroke volume(SV),and aortic valve velocity time integral(VTI)between the two groups(P>0.05).compared with the FR-negative group,the FR-positive group had higher SVV(16.68 ± 7.21%vs.11.15 ± 6.28%,P<0.05),△Vpeak(16.65 ± 5.23%vs.10.49 ± 5.87%,P<0.05)and △IVC(25.90±20.30%vs.13.89 ± 8.33%,P<0.05).2.In the comparison of hemodynamic indexes before and after PLR,the changes of HR,MAP,and CVP in the FR-positive group were not statistically significant(P>0.05),while SV and VTI increased significantly after PLR(P<0.05);In the FR-negative group,there were no significant changes in HR,MAP,CVP,SV,and VTI before and after PLR(P>0.05).3.Correlation analysis between various indicators and △SV.CVP1,△C VP and △SV have no significant correlation(r=0.066,P>0.05;r=0.019,P>0.05);SVV,△Vpeak,△IVC and PLR-△VTI are positive correlation with △SV(r=0.374,P<0.05;r=0.357,P<0.05;r=0.343,P<0.05;r=0.529,P<0.05).4.The ROC curve suggested that SVV,△Vpeak,ΔIVC,and PLR-△VTI had good predictive value for FR in elderly sepsis.The area under curve(AUC)(95%CI)was 0.722(0.556 to 0.853),respectively,0.797(0.638 to 0.909),0.705(0.538 to 0.840)and 0.841(0.688 to 0.938),the best cut-off values(sensitivity,specificity)are 12.00%(73.68%,75.00%),10.26%(89.47%,60.00%)),17.65%(68.42%,80.00%)and 11.11%(78.95%,80.00%),then the AUC of the above indicators were compared with each other by the Z test,and the results showed that there was no statistical difference(P>0.05).ConclusionFirst,△CVP has no predictive value for FR in elderly sepsis.Second,the relevant indicators monitored by ultrasound and PiCCO(Δ Vpeak,△IVC,PLR ΔVTI and SVV)have high predictive value for FR in elderly sepsis.Third,△Vpeak,△IVC,PLR-△VTI monitored under ultrasound and SVV monitored under PiCCO have no significant difference in the predictive accuracy for FR in elderly sepsis,however,diastolic function under ultrasound monitoring may be more beneficial to the volume management of this population.