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

Ključne reči: krv, volumen, hemodinamika, monitoring, infuzije, intravenske, rastvor, fiziološki, šok, septički, ultrasonografija

Sažetak

Uvod/Cilj. Septički šok (SŠ) je komplikacija koja može nastati kao posledica infekcije. S obzirom na to da je efektivni cirkulatorni volumen krvi od velike važnosti u ovim slučajevima, kontinuirano praćenje parametara volumena krvi je ključno. Cilj ovog rada je bio da se istraži značaj primene ultrazvuka za procenu odgovora na nadokandu volumena (volume responsiveness – VR) kod bolesnika sa SŠ. Metode. Odabrano je ukupno 102 bolesnika sa SŠ. Urađen je test volumenskog opterećenja (volume load – VL), i na osnovu rezultata testa, bolesnici su bili podeljeni u dve grupe. Jednu grupu činili su bolesnici koji su pokazali odgovor (response - R) na VL testu (grupa R); kod njih je povećanje udarnog volumena (stroke volume-SV) (ΔSV) bilo ≥ 15% posle VL testa. Drugu grupu (non-response – NR) činili su bolesnici kod kojih je ΔSV bio < 15% posle VL testa. U grupama je bilo 54 bolesnika (R) i 48 bolesnika (NR). Ispitivani hemodinamički parametri upoređivani su pre i posle VL testa. Korelacija između ΔSV i svakog pojedinačnog hemodinamičkog indeksa ispitivana je Pirsonovom analizom, a za određene parametre korišćene su ROC krive. Rezultati. Pre VL testa, veće vrednosti u grupi R u odnosu na grupu NR (p < 0,05) imali su sledeći indeksi: rastegljivost retro-hepatične (_RH) donje šuplje vene [inferior vena cava (IVC)] (Δ_RHIVC₁), respiratorna varijacija _RHIVC (Δ_RHIVC₂), respiratorna varijacija najveće brzine protoka krvi u aorti (ΔVpeak_AO), respiratorna varijacija najveće brzine protoka krvi u brahijalnoj arteriji (_BA) (ΔVpeak_BA) i respiratorna varijacija najveće brzine protoka krvi u zajedničkoj femoralnoj arteriji [common femoral artery (_CFA)](ΔVpeak_CFA). Frekvencija srca (FS), srednji arterijski pritisak (SAP) i centralni venski pritisak (CVP) su imali slične vrednosti (p > 0,05) u obe grupe. Nakon VL testa, grupa R imala je značajno smanjenje vrednosti FS i indeksa Δ_RHIVC₁, Δ_RHIVC₂, ΔVpeak_AO, ΔVpeak_BA i ΔVpeak_CFA, a povećanje vrednosti SAP i CVP (p < 0,05). Grupa NR imala je značajno smanjen CVP (p < 0,05), a nisu primećene značajne promene u vrednostima ostalih indeksa. Indeksi Δ_RHIVC₁, Δ_RHIVC₂, ΔVpeak_AO, ΔVpeak_BA i ΔVpeak_CFA bili su u značajnoj korelaciji sa ΔSV (r = 0,589, r = 0,647, r = 0,697, r = 0,621, r = 0,766, redom; p < 0.05 ), ali nije bilo korelacije između CVP i ΔSV (r = -0,345; p > 0,05). Površine ispod ROC krive [areas under the curve (AUC)] za indekse Δ_RHIVC₁, Δ_RHIVC₂, ΔVpeak_AO, ΔVpeak_BA i ΔVpeak_CFA, koji su korišćeni za predviđanje VR, iznosile su 0,839, 0,858, 0,878, 0,916 i 0,921 redom, i bile su značajno veće od AUC za CVP (0,691), što je ukazivalo da su indeksi Δ_RHIVC₁, Δ_RHIVC₂, ΔVpeak_AO, ΔVpeak_BA i ΔVpeak_CFA imali viši nivo osetljivosti i specifičnosti u poređenju sa CVP. Zaključak. Ultrazvučnim praćenjem indeksa Δ_RHIVC₁, Δ_RHIVC₂, ΔVpeak_AO, ΔVpeak_BA i ΔVpeak_CFA može se preciznije proceniti VR kod bolesnika sa SŠ.

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Korist od primene ultrazvuka za procenu odgovora bolesnika sa septičkim šokom na nadoknadu volumena

Sažetak

Reference