Application Value Of Optimal Width Of Inferior Vena Cava To Guide Individualized Fluid Management In Patients With Septic Shock

ObjectiveAt present,sepsis and septic shock still lead to high incidence and mortality rates in patients worldwide,and impose a heavy economic burden on society.Fluid therapy is the main method for treating sepsis and septic shock.However,early goal-directed therapy has proven to have no improvement in patients' prognosis in recent years.Excessive fluid therapy may cause prolonged mechanical ventilation,oxygenation dysfunction,renal insufficiency,and higher mortality,while insufficient fluid therapy cannot improve the perfusion of tissues and organs,and eventually lead to multi-organ failure and even death.With the concept of precision medicine and personalized medicine being proposed,it's hoped that there will be more accurate methods to guide patients' fluid therapy.The purpose of this trial is to study the combination of clinical manifestations,physiological indicators,and related hemodynamic indicators as well as dynamic monitoring of the inferior vena cava by bedside ultrasound and to put forward the concept of optimal inferior vena cava width which will be used to guide the individualized fluid therapy strategy that is compared with the conventional fluid treatment strategies of ICU,in order to evaluate whether it can improve the prognosis.MethodsThis study was a single-center randomized controlled clinical trial.A total of 82 patients with septic shock who were admitted to the Department of Intensive Medicine of Anhui Provincial Hospital from June 2017 to November 2019 were collected.Using a simple randomization method,the above patients were randomly divided into two groups,one of which was a control group.A total of 44 persons were administered fluid management in accordance with conventional ICU treatment.The other group is the intervention group,a total of 38 people.By dynamically monitoring the patient's blood pressure,heart rate,urine output,cardiac ultrasound and lung ultrasound,etc.,combined with the above multiple hemodynamic indicators,the patient reaches the liquid treatment goal after liquid treatment In addition,the B line of the lung has not increased(8 anchor points),and the right heart function has not deteriorated.The maximum diameter of the inferior vena cava at this time is defined as "Optimal width of inferior vena" cava,OVIVC)",with OWIVC as the reference value,individualized liquid management for patients,the measurement data is recorded by a special person and statistically compared.The main outcome is the volume of liquid in and out on the third and fifth days of the two groups and the cumulative liquid balance.The secondary outcomes were mechanical ventilation time,ICU hospital stay,mortality rate,and incidence of fluid-related complications.ResultsThere was no significant difference in general information such as gender,age,underlying disease,infection site,APACHE II score,SOFA score,and mechanical ventilation ratio between patients of the two groups(P> 0.05),which were comparable.The fluid intake in the first three days of the intervention group was lower than that in the control group [8445(7386.25,9638.75)vs 10392(8842.75,11912.5),P = 0.001].The fluid intake in the first five days of the intervention group was lower thanthat in the control group [13670(12312.5,15147.5)vs 17229.5(15492.5,19038.75),P = 0.001].The net liquid balance of the intervention group in the first three days was lower than that in the control group [1988(-2.5,3303)vs 3772.5(2582.25,5927.5),P = 0.001].In the first five days,the net fluid balance of the intervention group was lower than that in the control group [2332(735,5012.25)vs 6063(4472.75,7372.5),P = 0.001],The ICU mortality rate of the intervention group was lower than that of the control group [26.3%(10 / 38)vs 52.3%(23/44),P = 0.017].The new incidence of heart failure in the intervention group was lower than that in the control group [2.6%(1/38)vs 15.9%(7/44),P = 0.043 ],The new incidence of hypoxemia in the intervention group was lower than that in the control group [5.3%(2/38)vs 22.7%(10/44),P = 0.026],and the difference was statistically significant.ConclusionThe individualized liquid therapy program guided by the concept of optimal inferior vena cava width can reduce the patient intake,reduce the risk of complications related to fluid overload and improve the prognosis of patients.