Application value of bedside ultrasound for assessing volume responsiveness in patients with septic shock

Hao  He; Nifang  Pan; Xiaoyong Zhou

doi:10.2298/VSP220215069H

Hao He The Fourth Hospital of Changsha, Department of Critical Care Medicine, Changsha, Hunan Province, China
Nifang Pan Changshu Hospital Affiliated to Soochow University, Changshu No. 1 People's Hospital, Changshu, Jiangsu Province, China
Xiaoyong Zhou Center of Emergency and Intensive Care Unit, Shanghai, China

DOI: https://doi.org/10.2298/VSP220215069H

Keywords: blood volume, hemodynamic monitoring, infusions, intravenous, saline solution, shock, septic, ultrasonography

Abstract

Background/Aim. Septic shock (SS) is a complication that can occur as a consequence of an infection. As the effective circulating blood volume is of great importance in these cases, keeping constant track of the blood volume parameter is essential. The aim of this study was to explore the application value of bedside ultrasound for assessing volume responsiveness (VR) in patients with SS. Methods. A total of 102 patients with SS were selected. The volume load (VL) test was performed, and based on the results of the test, the patients were divided into two groups. The first group was the response (R) group, which had an increase in stroke volume (ΔSV) ≥ 15% after the VL test, and the second was the non-response (NR) group, with ΔSV < 15% after the VL test. There were 54 patients in the R group and 48 in the NR group. Hemodynamic parameters were compared before and after the VL test. The correlation between ΔSV and each hemodynamic index was explored by Pearson’s analysis. The receiver operating characteristic (ROC) curves were plotted for some of the parameters. Results. Before the VL test, retro-hepatic (_RH) inferior vena cava (IVC) (_RHIVC) distensibility (Δ_RHIVC₁) index, respiratory variation in _RHIVC (Δ_RHIVC₂) index, respiratory variation in aortic (_AO) blood flow peak velocity (ΔVpeak_AO) index, respiratory variation in brachial artery _(BA) blood flow peak velocity (ΔVpeak_BA) index, and respiratory variation in common femoral artery (_CFA) blood flow peak velocity (ΔVpeak_CFA) index were all higher in the R group than those in the NR group (p < 0.05), while heart rate (HR), mean arterial pressure (MAP), and central venous pressure (CVP) were similar in both groups (p > 0.05). After the VL test, the R group had significantly decreased values of HR and the Δ_RHIVC₁, Δ_RHIVC₂, ΔVpeak_AO, ΔVpeak_BA, and ΔVpeak_CFAindices, while the MAP and CVP values (p < 0.05) were increased. The NR group had a significantly decreased value of CVP (p < 0.05), while no significant changes were noticed in the values of other indices. The indices Δ_RHIVC₁, Δ_RHIVC₂, ΔVpeak_AO, ΔVpeak_BA, and ΔVpeak_CFA significantly correlated with ΔSV (r = 0.589, r = 0.647, r = 0.697, r = 0.621, r = 0.766, respectively; p < 0.05), but there was no correlation between CVP and ΔSV (r = -0.345; p > 0.05). The areas under the curve (AUC) of ROC graphics for Δ_RHIVC₁, Δ_RHIVC₂, ΔVpeak_AO, ΔVpeak_BA, and ΔVpeak_CFAindices_, used for the prediction of VR, were 0.839, 0.858, 0.878, 0.916, and 0.921, respectively, and were significantly larger than the AUC of ROC graphic for CVP (0.691), indicating higher sensitivity and specificity of the Δ_RHIVC₁, Δ_RHIVC₂, ΔVpeak_AO, ΔVpeak_BA, and ΔVpeak_CFA indices compared to CVP. Conclusion. Bedside ultrasound monitoring of the Δ_RHIVC₁, Δ_RHIVC₂, ΔVpeak_AO, ΔVpeak_BA, and ΔVpeak_CFAindices can assess the VR in patients with SS more precisely.

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