Analysis of volume management by comparing between critical care ultrasound examination and pulse indicator cardiac output in patients with septic shock

Mingwang Jia; Jialin Yang; Fang Peng; Yinling Wang; Guangyuan Liao; Yuanmei Gao

Analysis of volume management by comparing between critical care ultrasound examination and pulse indicator cardiac output in patients with septic shock

J Pak Med Assoc. 2020 Sep;70 [Special Issue](9):51-56.

Authors

Mingwang Jia¹, Jialin Yang¹, Fang Peng¹, Yinling Wang¹, Guangyuan Liao¹, Yuanmei Gao¹

Affiliation

¹ Department of Intensive Care Unit, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China.

PMID: 33177728

Abstract

Objective: To investigate volume management by comparing between critical care ultrasound examination and pulse indicator cardiac output (PICCO) in patient with septic shock.

Methods: Patients with septic shock during July 2017 and June 2018 were included. Inferior Vena Cava (IVC), total end-diastolic volume index (GEDI), central venous pressure (CVP), lactic acid and oxygenation index were measured by ultrasound. First, the accuracy difference of IVC, GEDI and CVP estimation capacity was compared. According to the changes of IVCmin, IVCmax, and GEDI, they were divided into 5 groups to compare the differences of lactic acid and oxygenation index between the groups and the correlation of lactate and Oxygenation index (PaO2/FiO2) between IVC and GEDI was analyzed. The correlation of lactate and PaO2/FiO2 between B lines and extravascular pulmonary water index (ELWI) was noted.

Results: The accuracy of IVC and GEDI in volume estimation was greater than 75%, significantly higher than that of CVP (53.3%) (P<0.05). The correlation results showed that GEDI was significantly correlated with IVCmax and IVCmin (P<0.05), while there was a significant correlation between b-line area and oxygenation index, ELWI and lactic acid, ELWI and oxygenation index (P<0.05). IVCmin, IVCmax and GEDI were respectively divided into 5 groups for comparing the difference between lactic acid and oxygenation. It was found that there were significant differences between the two indicators of IVCmin in different groups (P>0.05). The oxygenation index of the group ≤IVCmax was significantly lower than that of the group 0.5 ≤IVCmax < 1.0cm (P<0.05). The oxgenation indexes of groups 500≤GEDI < 600mL/m2; 600≤GEDI < 700mL/m2. 700≤GEDI < 800mL/m2 were significantly higher than that of group 0 < GEDI < 500mL/m2 (P<0.05).

Conclusions: Critical care ultrasound examination and PICCO are better methods than in volume management, but PICCO is more individualized, and PICCO in patients with valvular heart disease is not recommended.

Keywords: Critical care ultrasound, PICCO, Septic shock..

MeSH terms

Cardiac Output
Central Venous Pressure
Critical Care
Fluid Therapy
Humans
Shock, Septic*