Preload dependence indices to titrate volume expansion during septic shock: a randomized controlled trial
| Autor: | Véronique Leray, Claude Guérin, Gael Bourdin, Sophie Debord, Alina Stoian, Jean-Christophe Richard, Florent Wallet, Hodane Yonis, Bertrand Delannoy, Frédérique Bayle |
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| Jazyk: | angličtina |
| Rok vydání: | 2015 |
| Předmět: |
Male
medicine.medical_specialty Cardiac output Central Venous Pressure Critical Care and Intensive Care Medicine Internal medicine medicine Intravascular volume status Humans Vasoconstrictor Agents Prospective Studies Cardiac Output Aged Aged 80 and over Septic shock business.industry Research Central venous pressure Middle Aged medicine.disease Shock Septic Surgery Pulse pressure Preload SAPS II Shock (circulatory) Cardiology Fluid Therapy Female medicine.symptom business |
| Zdroj: | Critical Care |
| ISSN: | 1466-609X 1364-8535 |
| Popis: | IntroductionIn septic shock, pulse pressure or cardiac output variation during passive leg raising are preload dependence indices reliable at predicting fluid responsiveness. Therefore, they may help to identify those patients who need intravascular volume expansion, while avoiding unnecessary fluid administration in the other patients. However, whether their use improves septic shock prognosis remains unknown. The aim of this study was to assess the clinical benefits of using preload dependence indices to titrate intravascular fluids during septic shock.MethodsIn a single-center randomized controlled trial, 60 septic shock patients were allocated to preload dependence indices-guided (preload dependence group) or central venous pressure-guided (control group) intravascular volume expansion with 30 patients in each group. The primary end point was time to shock resolution, defined by vasopressor weaning.ResultsThere was no significant difference in time to shock resolution between groups (median (interquartile range) 2.0 (1.2 to 3.1) versus 2.3 (1.4 to 5.6) days in control and preload dependence groups, respectively). The daily amount of fluids administered for intravascular volume expansion was higher in the control than in the preload dependence group (917 (639 to 1,511) versus 383 (211 to 604) mL,P = 0.01), and the same held true for red cell transfusions (178 (82 to 304) versus 103 (0 to 183) mL,P = 0.04). Physiologic variable values did not change over time between groups, except for plasma lactate (time over group interaction,PP = 0.10). Intravascular volume expansion was lower in the preload dependence group for patients with lower simplified acute physiology score II (SAPS II), and the opposite was found for patients in the upper two SAPS II quartiles. The amount of intravascular volume expansion did not change across the quartiles of severity in the control group, but steadily increased with severity in the preload dependence group.ConclusionsIn patients with septic shock, titrating intravascular volume expansion with preload dependence indices did not change time to shock resolution, but resulted in less daily fluids intake, including red blood cells, without worsening patient outcome.Trial registrationClinicaltrials.govNCT01972828. Registered 11 October 2013. |
| Databáze: | OpenAIRE |
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