Clinical evaluation of transthoracic echocardiography predicting fluid responsiveness in septic shock

Objective To evaluate clinical value of transthoracic echocardiography (TTE) predicting fluid responsiveness in patients with severe sepsis or septic shock,the parameters of pulse indicator continuous cardiac output (PiCCO) system was combined.Methods Twenty-eight severe sepsis or septic shock patients with mechanically ventilated in intensive care unit (ICU) of Wannan Medical College Yijishan Hospital were prospectively observed from March 2011 to December 2012.The hemodynamic parameters including stoke volume (SV),cardiac output(CO),cardiac output index (CI) and the distensibility index of the inferior vena cava (dIVC),descending aortic blood flow (ABF) were measured by PiCCO and/or TTE in the supine position.Responders were defined by the appearance of an increase in SV (△ SV) ≥ 10％ after liquid loading.The value of TTE predicting fluid responsiveness was evaluated in severe sepsis or septic shock patients.Results There were a total of 53 times liquid loading test in 28 patients,of which with 30 times was positive.The area under receiver operating characteristic curve(ROC curve,AUC) for dIVC predicting fluid responsiveness was 0.887,the dlVC threshold value of 22.5％ had the sensitivity of 83.3％ and specificity of 82.6％ for prediction of fluid responsiveness.The AUC for A BF predicting fluid responsiveness was 0.794,the ABF variation threshold value of 10.95％ had the sensitivity of 86.7％ and specificity of 73.9％ for prediction of fluid responsiveness.The AUC for SVTIE predicting fluid responsiveness was 0.919,the △ SV of 12.9％ had the sensitivity of 96.7％ and specificity of 87.0％ for prediction of fluid responsiveness.The SV,CO,CI of TTE were highly correlated with the SV,CO,CI of PiCCO before and after liquid loading (before liquid loading,r=0.901,0.940,0.909,after liquid loading r=0.911,0.951,0.940,all P=0.000).Conclusion Fluid responsiveness can be predicted using TTE in severe sepsis or septic shock patients. Key words: Transthoracic echocardiography;  Septic shock;  Fluid responsiveness