Clinical value of global end-diastolic volume index for fluid resuscitation in cardiac dysfunction patients with septic shock

Abstract

Objective To explore the value of global end-diastolic volume index (GEDI) for fluid resuscitation in cardiac dysfunction patients with septic shock. Methods A total of 41 cardiac dysfunction patients with septic shock hospitalized in the Department of Intensive Care Unit of Affiliated Hospital of Hangzhou Normal University from January 2016 to January 2018 were randomly divided into the central venous pressure (CVP) group (n = 21) and GEDI group (n = 20). Patients in the CVP group were treated with standard early goal-directed therapy recommended in sepsis guidelines. Patients in the GEDI group were monitored by pulse-indicated continuous cardiac output and performed fluid resuscitation directed by GEDI to ensure GEDI should reach 680 ~ 800 mL / m2; other goals of treatment, including mean arterial pressure, central venous oxygen saturation and urine volume, were equal to standard EGDT. The fluid volume when achieved resuscitation goals, 24 h extravascular lung water index (EVLWI), 6 h and 24 h brain natriuretic peptide, blood lactate clearance rate, and norepinephrine dosage were recorded. Results The liquid volume was less in the GEDI group than in CVP group [(2 572 ± 1108) mL vs. (3 327 ± 925) mL, t = 2.375, P = 0.023]. Compared to the CVP group, 24 h EVLWI [7.3 (5.5, 8.8) mL / kg vs. 9.6 (8.9, 9.8) mL / kg], 6 h brain natriuretic peptide [889.0 (340.3, 1 270.0) ng / L vs. 1 746.0 (634.0, 2 160.0) ng / L] and 24 h brain natriuretic peptide [684.5 (192.5, 749.9) ng / L vs. 1 120.0 (400.5, 2 480.0) ng / L] were lower in the GEDI group (Z = 86.500, 120.000, 124.000; P = 0.001, 0.020, 0.026). Blood lactate clearance rate in 6 h [34.21 (15.64, 45.87)% vs. 20.00 (0.00, 33.19)%] was higher, and the norepinephrine dosage [(0.9 ± 0.6) mg / kg vs. (1.9 ± 1.5) mg / kg] was less in the GEDI group than in the CVP group (Z = 129.500, t' = 2.817; P = 0.037, 0.009). Conclusion GEDI-directed EGDT can achieve liquid resuscitation targets more effectively in cardiac dysfunction patients with septic shock, with less fluid volume, vasoactive agent, extravascular lung water and cardiac function impairment. Key words: Shock, septic; Global end-diastolic volume index; Fluid resuscitation