Central venous pressure in combination with visual left ventricular ejection fraction as an indicator of fluid responsiveness in patients with septic shock

Abstract

Objective To investigate the value of central venous pressure(CVP) combined with visual left ventricular ejection fraction(LVEF)as an indicator of fluid responsiveness in patients with septic shock. Methods A retrospective analysis of 83 patients with septic shock receiving fluid challenge was conducted. The hemodynamic changes were evaluated with the pulse indicator continuous cardiac output (PiCCO) monitor, and all the patients were divided into two groups: the responded group(△CI% ≥ 15%)and the unresponded group(△CI < 15%), according to the change in CI(△CI%). Those patients were divided into several subgroups, including low CVP group(CVP < 8 mmHg) and high CVP group(CVP ≥ 8 mmHg), low LVEF group(LVEF < 50%) and high LVEF group(LVEF ≥ 50%), according to the initial value of CVP and LVEF. The changes in hemodynamic variables were compared before and after fluid challenge in each subgroup. The ability of CVP and visual LVEF was evaluated to predict fluid responsiveness with receiver operating characteristic curves. Results Fifty three (63.9%)patients responded to the fluid challenge, and lower CVP and higher LVEF patients were more frequency in responded group. The threshold value of 8 mmHg CVP for prediction of fluid responsiveness revealed the area under the curve (AUC) of 0.646(P=0.219), and 50% visual LVEF revealed AUC of 0.729(P=0.023). CVP in combination with visual LVEF for prediction of fluid responsiveness showed an AUC of 0.817 (P=0.001) with a sensitivity of 76.3% and a specificity of 88.2%. Conclusions Visual LVEF alone and combined with CVP can be used as an indicator of fluid responsiveness in patients with septic shock. Key words: Central venous pressure; Heart ventricles/US; Ventricular function, left; Stroke volume; Shock/DI/PP; Hemodynamics