Pulse Indicator Continuous Cardiac Output Monitoring Research Articles

Pulmonary Vascular Permeability and Extravascular Lung Water Index in Patients with Liver Cirrhosis and Septic Shock.

Backgrounds and Aims: Patients with cirrhosis are susceptible to sepsis and septic shock. Cirrhotic patients also have increased capillary permeability and are prone to developing volume overload. Patients with septic shock may have an enhanced pulmonary vascular permeability index (PVPI) and extravascular lung water index (EVLWI), both of which are associated with an unfavorable prognosis. It is plausible that pre-existing hyperpermeability may deteriorate when cirrhotic patients develop septic shock. However, it remains unknown whether PVPI and EVLWI can predict the prognosis of cirrhotic patients with septic shock. Pulse Indicator Continuous Cardiac Output (PiCCO) is an established tool to measure PVPI and EVLWI. Therefore, we conducted this retrospective study to investigate the prognostic significance of PVPI and EVLWI in cirrhotic patients with septic shock using PiCCO monitoring. Methods: We included 83 patients with liver cirrhosis and septic shock. EVLW indexed to actual body weight (aEVLWI), EVLW indexed to predicted body weight (pEVLWI), PVPI, disease severity scores, and other biomarkers were analyzed. We collected the PiCCO data on the first 2 days. Results: The overall 28-day mortality was 43.4%. The values of PVPI, aEVLWI, and pEVLWI on day 2 (PVPID2, aEVLWID2, EVLWID2) were significantly higher in non-survivors. The discriminating power of PVPID2 and EVLWID2 to predict 28-day mortality was tested using the area under a ROC curve. The areas under ROC curves (mean ± SEM) were 0.713 ± 0.061 and 0.650 ± 0.063 for PVPID2 and pEVLWID2. In the multivariate analysis, PVPID2, bilirubin, and lactate were independent factors which predicted 28-day mortality. Conclusions: Higher levels of PVPID2 and pEVLWID2 are associated with higher 28-day mortality rates in cirrhotic patients with septic shock. PVPI and pEVLWI may be useful to guide fluid management in this clinical setting.

Evaluation of extravascular lung water index in critically ill patients based on lung ultrasound radiomics analysis combined with machine learning

To explore lung ultrasound radiomics features which related to extravascular lung water index (EVLWI), and to predict EVLWI in critically ill patients based on lung ultrasound radiomics combined with machine learning and validate its effectiveness. A retrospective case-control study was conducted. The lung ultrasound videos and pulse indicated continuous cardiac output (PiCCO) monitoring results of critically ill patients admitted to the department of critical care medicine of the First Affiliated Hospital of Guangxi Medical University from November 2021 to October 2022 were collected, and randomly divided into training set and validation set at 8:2. The corresponding images from lung ultrasound videos were obtained to extract radiomics features. The EVLWI measured by PiCCO was regarded as the "gold standard", and the radiomics features of training set was filtered through statistical analysis and LASSO algorithm. Eight machine learning models were trained using filtered radiomics features including random forest (RF), extreme gradient boost (XGBoost), decision tree (DT), Naive Bayes (NB), multi-layer perceptron (MLP), K-nearest neighbor (KNN), support vector machine (SVM), and Logistic regression (LR). Receiver operator characteristic curve (ROC curve) was plotted to evaluate the predictive performance of models on EVLWI in the validation set. A total of 151 samples from 30 patients were enrolled (including 906 lung ultrasound videos and 151 PiCCO monitoring results), 120 in the training set, and 31 in the validation set. There were no statistically significant differences in main baseline data including gender, age, body mass index (BMI), mean arterial pressure (MAP), central venous pressure (CVP), heart rate (HR), cardiac index (CI), cardiac function index (CFI), stroke volume index (SVI), global end diastolic volume index (GEDVI), systemic vascular resistance index (SVRI), pulmonary vascular permeability index (PVPI) and EVLWI. The overall EVLWI range in 151 PiCCO monitoring results was 3.7-25.6 mL/kg. Layered analysis showed that both datasets had EVLWI in the 7-15 mL/kg interval, and there was no statistically significant difference in EVLWI distribution. Two radiomics features were selected by using LASSO algorithm, namely grayscale non-uniformity (weight was -0.006 464) and complexity (weight was -0.167 583), and they were used for modeling. ROC curve analysis showed that the MLP model had better predictive performance. The area under the ROC curve (AUC) of the prediction validation set EVLWI was higher than that of RF, XGBoost, DT, KNN, LR, SVM, NB models (0.682 vs. 0.658, 0.657, 0.614, 0.608, 0.596, 0.557, 0.472). The gray level non-uniformity and complexity of lung ultrasound were the most correlated radiomics features with EVLWI monitored by PiCCO. The MLP model based on gray level non-uniformity and complexity of lung ultrasound can be used for semi-quantitative prediction of EVLWI in critically ill patients.

Clinical value of pulse pressure/central venous pressure ratio in low cardiac output syndrome after cardiac surgery

To explore the relationship between the pulse pressure/central venous pressure (PP/CVP) ratio and the cardiac output (CO) of patients after cardiac surgery from the basic principles of hemodynamics, and to further evaluate the predictive value of PP/CVP ratio in patients with secondary low cardiac output syndrome (LCOS) after cardiac surgery. A retrospective study was conducted, and patients who received pulse indicator continuous cardiac output (PiCCO) monitoring were enrolled at the department of critical care medicine of Peking Union Medical College Hospital from January 1, 2016, to September 1, 2021. Patients were divided into two groups: the LCOS group [cardiac index (CI) < 33.34 mL×s-1×m-2, 25 cases] and the non-LCOS group (CI ≥ 33.34 mL×s-1×m-2, 125 cases) according to the CI at 6 hours after surgery. The general clinical data and hemodynamic parameters were collected. Correlations between PP/CVP ratio and PiCCO monitoring indicators were performed with Pearson or Spearman correlation test. Receiver operator characteristic curve (ROC curve) analysis was carried out to evaluate the predictive value of the parameters in patients with LCOS after cardiac surgery. A total of 150 patients with PiCCO monitoring after cardiac surgery were included. There were no differences in baseline characteristics between the two groups, while PP in the LCOS group was lower than that in the non-LCOS group [mmHg (1 mmHg ≈ 0.133 kPa): 40 (37, 44) vs. 55 (46, 64)], CVP was higher than that in the non-LCOS group [mmHg: 12 (11, 14) vs. 10 (8, 12)], and PP/CVP ratio in the LCOS group was lower than that in the non-LCOS group [3.3 (2.9, 3.7) vs. 5.5 (4.6, 6.8)], with significant differences (all P < 0.05). Correlation analysis results showed that PP/CVP ratio was positively correlated with CI, CO, and stroke volume index (SVI), respectively (rs = 0.660, 0.592, 0.600, all P < 0.001). CI was negatively correlated with PP (rs = 0.509, P < 0.001) and positively correlated with CVP (rs = -0.297, P < 0.001). ROC curve analysis revealed that compared with PP, CVP, SVI and cardiac function index (CFI), PP/CVP ratio was the best predictor of LCOS after cardiac surgery [area under the ROC curve (AUC) was 0.94±0.02, P < 0.001], when the optimum cut-off value was 4.41, the sensitivity was 80.00%, and the specificity was 96.00%. PP/CVP ratio was moderately positively correlated with CO after cardiac surgery, and PP/CVP ratio could be used as a prognostic predictor for LCOS after cardiac surgery.

Effect of Pulse Indicator Continuous Cardiac Output Monitoring on Septic Shock Patients: A Meta-Analysis.

Background Septic shock (SS) is the most common severe syndrome in the Intensive Care Unit (ICU). Enhancing the monitoring of hemodynamic indexes in SS patients carries huge clinical implications for reducing patient mortality. Recently, pulse indicator continuous cardiac output (PICCO) has been widely used in clinical practice, but its advantages than central venous pressure (CVP) in guiding the treatment of SS patients remains to be refined. Therefore, this study is aimed at assessing the clinical effects of PICCO in the treatment of patients with SS. Methods The authors systematically searched several databases (PubMed, EMBASE, Cochrane Library, and China National Knowledge) between January 2001 and February 2021. When searching for relevant articles, the authors combined the following phrases describing the monitoring group (“pulse indicator continuous cardiac output,” “central venous pressure”) with the disease of interest as well as management (“SS,” “sepsis”). The outcomes were independently assessed by two reviewers who scored the articles for methodological quality using the Cochrane Collaboration's “risk of bias” tool. Forest plots, as well as sensitivity and bias analyses, were carried out for the included articles. The primary outcome measures were length of ICU stay, duration of mechanical ventilation, 28-day mortality, and fluid resuscitation volume. Results Ten studies comprising 350 cases monitored with PICCO and 373 cases monitored with traditional CVP were eventually identified. PICCO-monitored patients were observed to be significantly associated with shorter ICU stay than CVP-monitored patients (MD: −3.04, 95% CI: −4.74 to −1.34, P = 0.0005), shorter time of mechanical ventilation (MD: −1.84, 95% CI: −2.80 to −0.87, P = 0.0002), and lower 28-day mortality (RR: 0.67, 95% CI: 0.48 to 0.94, P = 0.02). The two groups showed no significant difference in subgroup analysis for fluid resuscitation volumes (P > 0.05). Conclusion PICCO monitoring technique can significantly improve the prognosis of SS patients, shorten the time of mechanical ventilation and ICU stay, and reduce the 28-day mortality, which has positive guiding significance for patients with SS. Given the limitations of the quantity and quality of included studies, further research is warranted to verify the conclusions.

The fluid management and hemodynamic characteristics of PiCCO employed on young children with severe hand, foot, and mouth disease\u2014a retrospective study

BackgroundHand, foot, and mouth disease (HFMD) is an acute infectious disease caused by human enterovirus 71 (EV71), coxsackievirus, or echovirus, which is particularly common in preschool children. Severe HFMD is prone to cause pulmonary edema before progressing to respiratory and circulatory failure; thus hemodynamic monitoring and fluid management are important to the treatment process.MethodsWe did a review of young patients who had been successfully treated in our department for severe HFMD, which had been caused by EV71. A total of 20 patients met the inclusion criteria. Eight cases were monitored by the pulse indicator continuous cardiac output (PiCCO) technique, and fluid management was administered according to its parameters. With regard to the treatment with PiCCO monitoring, patients were divided into two groups: the PiCCO group (8 patients) and the control group (12 patients). The groups were then compared comprehensively to evaluate whether PiCCO monitoring could improve patients’ clinical outcomes.ResultsAfter analysis, the findings informed that although PiCCO failed to shorten the length of ICU stay, reduce the days of vasoactive drug usage, or lower the number of cases which required mechanical ventilation, PiCCO did reduce the incidence of fluid overload (p = 0.085) and shorten the days of mechanical ventilation (p = 0.028). After effective treatment, PiCCO monitoring indicated that the cardiac index (CI) increased gradually(p < 0.0001), in contrast to their pulse (P, p < 0.0001), the extra vascular lung water index (EVLWI, p < 0.0001), the global end diastolic volume index (GEDVI, p = 0.0043), and the systemic vascular resistance index (SVRI, p < 0.0001), all of which decreased gradually.ConclusionOur study discovered that PiCCO hemodynamic monitoring in young children with severe HFMD has some potential benefits, such as reducing fluid overload and the duration of mechanical ventilation. However, whether it can ameliorate the severity of the disease, reduce mortality, or prevent multiple organ dysfunction remain to be further investigated.

Preliminary establishment of weaning prediction model

To establish a model that can predict weaning failure from ventilation through hemodynamic and fluid balance parameters. A retrospective analysis was conducted. The patients who underwent invasive mechanical ventilation for more than 24 hours and having spontaneous breathing test admitted to intensive care unit (ICU) of Tianjin Third Central Hospital from January 1st, 2017 to December 31st, 2018 were enrolled. The information was collected, which included the baseline data, hemodynamic parameters by pulse indicator continuous cardiac output (PiCCO) monitoring, B-type natriuretic peptide (BNP), urinary output, fluid balance in first 24 hours when patients admitted to ICU, and hemodynamic parameters by PiCCO monitoring, BNP, urinary output, fluid balance, diuretic usage, noradrenalin usage within 24 hours before weaning as well as usage of continuous renal replacement therapy (CRRT) during mechanical ventilation. According to weaning success or failure, the patients were divided into weaning success group and weaning failure group, and the statistical differences between the two groups were calculated. Variables with statistical significance within 24 hours before weaning were included in the multivariate Logistic regression analysis to establish weaning failure prediction model and find out the possible risk factors of weaning failure. A total of 159 patients were included in this study, which included 138 patients in the weaning success group and 21 patients in the weaning failure group. There were no statistical differences in all hemodynamic parameters by PiCCO monitoring, BNP, urinary output, fluid balance within 24 hours into ICU between two groups. There were statistical differences in BNP (χ2 = 9.262, P = 0.026), central venous pressure (CVP; χ2 = 7.948, P = 0.047), maximum rate of the increase in pressure (dPmx; χ2 = 10.486, P = 0.015), urinary output (χ2 = 8.921, P = 0.030), fluid balance (χ2 = 9.172, P = 0.027) within 24 hours before weaning between two groups. In addition, variable about cardiac index (CI; χ2 = 7.789, P = 0.051) was included into multivariate Logistic regression model to improve the prediction model and enhance the accuracy of model. Finally, variables included in the multivariate Logistic regression model were BNP, CVP, CI, dPmx, urinary output, fluid balance volume, and the accuracy of the weaning failure prediction model was 92.9%, the sensitivity was 100%, and the specificity was 76.8%. When the model was adjusted by variables of age and noradrenalin usage, the accuracy of model to predict failure of weaning was 94.2%, the sensitivity was 100%, the specificity was 81.2%. Weaning failure prediction model based on hemodynamic parameters by PiCCO monitoring and variables about liquid balance has high accuracy and can guide clinical weaning.

Comparison of critical care resources between second-class hospitals and third-class hospitals in Guizhou Province of China

To know the critical care resources of the different class-hospitals in Guizhou Province, China, and to provide the direction and evidence for quality improvement and discipline construction of critical care medicine in Guizhou Province. The resource status of the departments of intensive care unit (ICU) in Guizhou Province was obtained through form filling and/or field investigation. The forms were filled and submitted from May 2017 to February 2018, and the field investigation (some of the hospitals) was carried out in March 2018. The data of hospitals in Guizhou Province in 2018, was obtained from the official website of Health Committee of Guizhou Province, which was released online on November 28th, 2019. The obtained data were summarized and analyzed according to different aspects such asthe status of ICU construction, main equipment configuration and technology implementation. There were 39 third-class hospitals and 77 second-class hospitals included in this study, which accounted for 76.5% (39/51) of third-class public hospitals and 50.0% (77/154) of second-class public hospitals respectively. Among them, there were 86.8% (33/38) of third-class general hospitals and 50.4% (69/137) of second-class general hospitals respectively. In terms of ICU construction, compared with the ICUs of second-class hospitals, the ICUs of third-class hospitals were established earlier [years: 2011 (2008, 2012) vs. 2013 (2011, 2015), P < 0.01], had more ICU beds, doctors and nurses [15 (11, 20) vs. 8 (6, 10), 9 (8, 11) vs. 6 (5, 7), 25 (20, 41) vs. 15 (12, 19), respectively, all P < 0.01]. However, there were no significant differences regarding the doctor-bed ratio and the nurse-bed ratio in ICUs between second-class hospitals and third-class hospitals. In terms of main equipment configuration, compared with the ICUs of second-class hospitals, the ICUs of third-class hospitals had more ventilators, higher ratio of ventilators to beds, more infusion pumps, higher ratio of infusion pumps to beds, more monitor, gastrointestinal nutrition pumps and single rooms, and higher proportion of ICUs equipped with negative pressure rooms [ventilators: 14 (10, 18) vs. 6 (4, 8), ratio of ventilators to beds: 1.0 (0.7, 1.1) vs. 0.8 (0.6, 1.0), infusion pumps: 10 (6, 20) vs. 5 (3, 8), ratio of infusion pumps to beds: 0.8 (0.0, 1.0) vs. 0.0 (0.0, 0.4), monitor: 18 (13, 24) vs. 9 (6, 12), gastrointestinal nutrition pumps: 2 (1, 5) vs. 1 (0, 3), single rooms: 2 (1, 3) vs. 1 (0, 3), proportion of ICUs equipped with negative pressure rooms: 53.8% (21/39) vs. 31.5% (23/73), respectively, all P < 0.05]. Furthermore, there were higher proportions of ICUs equipped with portable ventilator, pulse indicator continuous cardiac output monitoring (PiCCO), intra-aortic balloon pump (IABP), extra-corporeal membrane oxygenation (ECMO), B ultrasound machine, bronchoscope, pressure of end-tidal carbondioxide (PETCO2) monitoring, bispectral index (BIS) monitoring, bedside gastroscopy, the apparatus used for the prevention of deep vein thrombosis of lower extremity in third-class hospitals than in second-class hospitals [portable ventilator: 86.7% (26/30) vs. 59.6% (28/47), 43.3% (13/30) vs. 1.5% (1/66), 14.3% (4/28) vs. 0% (0/65), 10.7% (3/28) vs. 0% (0/65), 62.5% (20/32) vs. 37.3% (25/67), 97.1% (33/34) vs. 63.6% (42/66), 60.6% (20/33) vs. 28.4% (19/67), 17.2% (5/29) vs. 0% (0/65), 27.6% (8/29) vs. 1.5% (1/65), 77.4% (24/31) vs. 52.3% (34/65), respectively, all P < 0.05]. In terms of skills development, there were more ICUs carried out intracranial pressure monitoring, abdominal pressure monitoring, ultrasound diagnosis, bronchoscope examination and treatment and blood purification in third-class hospitals than in second-class hospitals [31.6% (12/38) vs. 14.7% (11/75), 75.7% (28/37) vs. 38.6% (27/70), 61.5% (24/39) vs. 24.3% (18/74), 89.7% (35/39) vs. 45.9% (34/74), 92.3% (36/39) vs. 48.6% (36/74), respectively, all P < 0.05]. The data were mainly derived from public general hospitals in Guizhou Province. Compared with the ICUs of second-class hospitals, the ICUs of third-class hospitals were founded earlier and larger, had better hardware configuration and could carry out more skills. However, the human resource situations were similar between second-class hospitals and third-class hospitals. Both second-class hospitals and third-class hospitals have a need to improve the allocation of manpower and equipment and expand various skills in ICUs, while it is more urgent for second-class hospitals.

Clinical research of target guided treatment of patients with severe heart failure under the guidance of pulse indicator continuous cardiac output

To investigate the value of pulse indicator continuous cardiac output (PiCCO) monitoring in the treatment management of patients with severe heart failure. Sixty patients of severe heart failure admitted to intensive care unit (ICU) of Fujian Provincial Hospital from August 2017 to February 2019 were enrolled, and they were divided into control group and treatment group according to random number table method, with 30 in each group. The treatment group used bedside PiCCO to carry out minimally invasive hemodynamics monitoring, according to the monitoring data target guidance for vasoactive drugs and liquid management. The control group was based only on traditional electrocardiogram (ECG) monitoring and lung sound, urine volume of vasoactive drugs and liquid management. The changes of cardiac index (CI), global end diastolic volume index (GEDVI), extravascular lung water index (EVLWI), systemic vascular resistance index (SVRI), invasive mean arterial pressure (MAP) and central venous pressure (CVP) were observed before and 72 hours after treatment in the treatment group. The 7-day total effective rate, the length of ICU stay and 28-day mortality were compared between the two groups. Compared with before treatment, CI and MAP in the treatment group were significantly increased after treatment [CI (mL×s-1×m-2): 53.34±16.67 vs. 35.01±13.34, MAP (mmHg, 1 mmHg = 0.133 kPa): 72.6±10.6 vs. 62.5±10.3, both P < 0.05], GEDVI, EVLWI, SVRI, CVP were significantly decreased [GEDVI (mL/m2): 760.3±90.2 vs. 960.2±110.3, EVLWI (mL/kg): 6.5±1.3 vs. 12.5±6.2, SVRI (kPa×s×L-1×m-2): 297.3±35.1 vs. 434.1±58.8, CVP (mmHg): 10.1±2.6 vs. 12.2±3.4, all P < 0.05]. Compared with the control group, the 7-day total effective rate of the treatment group was significantly higher (90.0% vs. 80.0%), the length of ICU stay was significantly shorter (days: 8.2±4.5 vs. 10.3±2.5), and the 28-day mortality was significantly lower, with statistically significant difference (all P < 0.05). PiCCO monitoring is a goal-oriented treatment management for patients with severe heart failure, which is helpful to individualized accurate treatment, shorten the length of ICU stay and improve short-term prognosis.

Efficacy of PiCCO monitoring in guiding volume therapy in patients with sepsis complicated with acute kidney injury

Objective To evaluate the efficacy of pulse indicator continuous cardiac output (PiCCO) monitoring in guiding volume therapy in patients with sepsis complicated with acute kidney injury. Methods Eighty-five patients with sepsis complicated with acute kidney injury were divided into PiCCO group (n=37) and routine group (n=48) according to whether PiCCO monitoring was used to guide volume therapy.The hemodynamic parameters at 6 and 24 h after volume therapy, fluid volume, consumption of vasoactive drugs, renal function, fatality in intensive care unit and 28-day fatality were recorded. Results Compared with routine group, the volume of fluid for resuscitation at 24 h after volume therapy, and central venous pressure were significantly decreased (P<0.05), the time of continuous renal replacement therapy was shortened, the urine volume was increased, the blood creatinine level was decreased, and the fatality rate in intensive care unit and 28-day fatality rate were decreased in group PiCCO (P<0.05). Conclusion For the patients with sepsis complicated with acute kidney injury, PiCCO monitoring can reasonably guide volume therapy and is helpful in improving the prognosis. Key words: Cardiac output; Catheterization, Swan-Ganz; Monitoring, physiologic; Sepsis; Fluid therapy; Acute kidney injury

The ultrasonic monitoring coupled with passive leg raising test for evaluation of fluid responsiveness in critical patients

Objective To explore the value of predicting fluid responsiveness using velocity time index variation (ΔVTI) and stroke volume variation (ΔSV) before and after passive leg raising (PLR) monitored by bedside temporary test equipment (TTE). Methods A cohort of 42 patients supported with mechanical ventilation in our hospital admitted from October 2014 to October 2015 were prospectively selected. The hemodynamic variables including heart rate (HR), mean arterial pressure (MAP), central venous pressure (CVP), VTI, SV and other parameters were monitored before and after after undergoing PLR. Fluid resuscitation volume expansion test was carried out after stroke volume index (SVI) monitored by pulse indicator continuous cardiac output monitoring (PICCO). Patients were divided into fluid responsiveness positive group and fluid responsiveness negative group according to presence or absence of SVI ≥ 15% after fluid resuscitation volume expansion. Results Of 42 patients, 22 belonged to fluid responsiveness positive group, 20 got into fluid responsiveness negative group. There were no significant differences in basic clinical data between two groups. Before and after PLR, there were no distinct changes in HR and CVP(P>0.05), while MAP, VTI and SV increased significantly(P 0.05), but HR, CVP and VTI increased significantly(P<0.05) in fluid responsiveness negative group. The degrees of ΔVTI and ΔSV in fluid responsiveness positive group were much higher than those in fluid responsiveness negative group (P<0.05). According to SVI ≥ 15% monitored by PICCO after fluid resuscitation volume expansion test as a standard, the area under the ROC (AUC) of ΔVTI between pre-PLR and post-PLR was 0.75 (95%CI: 0.593-0.907, P<0.01), the sensitivity and specificity were 63.6% and 95% respectively using ΔVTI 15.6% as threshold value. The AUC of ΔSV was 0.844 (95%CI: 0.716-0.972, P<0.01), the sensitivity and specificity were 81.8% and 85.0% respectively using ΔSV 10.5% as threshold value. Conclusion ΔVTI and ΔSV monitored by TTE before and after PLR could be employed for predicting fluid responsiveness of critical patients under the status of spontaneous respiration.Their value for prediction of critical patients could be further improved by combined employment of these two indexes of variation. Key words: Transthoracic echocardiography; Fluid responsiveness; Passive leg raising

Accuracy of different methods in predicting fluid responsiveness in septic patients: a comparison between ultrasound, PiCCO and traditional methods

Objective To compare the accuracy of ultrasound, pulse indicator continuous cardiac output monitoring (PiCCO) and traditional methods in predicting fluid responsiveness in septic patients. Methods Forty-six septic patients of both sexes, aged 18-72 yr, requiring mechanical ventilation treatment in the intensive care unit, were enrolled in the study.Venous blood samples were collected for determination of plasma B-type natriuretic peptide (BNP) concentrations by chemiluminescence assay, and central venous pressure (CVP) was recorded.Stroke volume variation (SVVTTE), distensibility index of inferior vena cava (dIVC) and velocity time integral changes of aortic blood flow (ΔVTI) were measured by ultrasound method.SVVPiCCO and global end-diastolic volume index (GEDVI) were measured by PiCCO method.The patients were divided into negative fluid responsiveness group and positive fluid responsiveness group according to the fluid responsiveness after volume expansion.The receiver operating characteristic curves of the parameters mentioned above in predicting fluid responsiveness were drawn.A consistency check for dIVC, ΔVTI and SVVPiCCO thresholds was conducted by using Kappa statistics.The agreement between SVVTTE and SVVPiCCO was analyzed by the Bland-Altman analysis. Results There were 24 patients in positive fluid responsiveness group and 22 patients in negative fluid responsiveness group.Compared with negative fluid responsiveness group, the plasma BNP concentration, CVP and GEDVI were significantly decreased, and SVVPiCCO, SVVTTE, dIVC and ΔVTI were increased before volume expansion in positive fluid responsiveness group (P<0.05). The area under the curve (95% confidence interval), sensitivity and specificity of the plasma BNP concentration were 0.894 (0.807-0.981), 81.8% and 79.2%, respectively, of CVP 0.859 (0.752-0.965), 81.8% and 79.2%, respectively, of GEDVI 0.772 (0.628-0.915), 72.7% and 75.0%, respectively, of SVVPiCCO 0.965 (0.922-1.008), 95.8% and 81.8%, respectively, of SVVTTE 0.940 (0.874-1.006), 91.7% and 86.4%, respectively, of dIVC 0.964 (0.920-1.008), 83.3% and 95.5%, respectively, and of ΔVTI 0.958 (0.909-1.008), 87.5% and 90.9%, respectively.The Kappa value for dIVC threshold and SVVPiCCO threshold was 0.826, and for ΔVTI threshold and SVVPiCCO threshold was 0.743 (P<0.01). The mean deviation of SVVTTE and SVVPiCCO was 0.209, 95% confidence interval (-2.967-3.385)%, and the limit of agreement (-2.46-2.62)%(P<0.05). Conclusion Ultrasound and PiCCO methods can accurately predict fluid responsiveness, have a good agreement and are superior to the traditional method in septic patients. Key words: Echocardiography; Monitoring, physiologic; Vascular capacitance; Sepsis

The influence of continuous veno-venous hemofiltration on cardiac output value monitored by transpulmonary thermodilution technique in critical patients

To investigate the influence of continuous veno-venous hemofiltration (CVVH) on cardiac output (CO) value and parameters of hemodynamics monitored by transpulmonary thermodilution technique in critical patients. A prospective cohort study was conduced. Sixty-two critical patients admitted to intensive care unit (ICU) of Zunyi Medical College Affiliated Hospital from January 2011 to October 2015 were enrolled. All of the patients received CVVH through femoral vein puncture catheter. The CO value was monitored before CVVH operation, immediately after CVVH operation (8?centigrade normal saline was injected immediately after the output of blood from the arterial end), 5 minutes after operation, the time at the sudden interruption (press pause key after 10 minutes of operation) and resumed immediately, 15 minutes and 30 minutes after operation by pulse-indicated continuous cardiac output (PiCCO) with transpulmonary thermodilution method. The changes in heart rate (HR), mean arterial pressure (MAP), central venous pressure (CVP), and blood temperature were observed at all time points. From CVVH before start to 5 minutes thereafter, CO values were not significantly changed in patients, fluctuating in 6.96 (7.33, 8.67)-6.98 (6.43, 7.45) L/min. When CVVH was suddenly interrupted, CO value was immediately increased to the peak 8.04 (7.36, 8.77) L/min, which showed statistically significant difference as compared with other time points (all P < 0.01). Immediately after the CVVH recovery from interruption, the CO value dropped to 4.71 (4.14, 7.26) L/min, and it was significantly lower than those at other time points (all P < 0.01). With the CVVH recovery, the patients' CO value was gradually restored to the stable operation ahead of interruption [4.71 (4.14, 7.26)-6.85 (6.08, 7.26) L/min]. During CO monitoring, HR, MAP, CVP and blood temperature of the patients were at the same level, and no significant changes were founded. CVVH interruption of immediate PiCCO monitoring CO value were significantly increased, immediately after the CVVH recovery the CO value were significantly reduced, and the normal operation of CVVH did not affect the CO value monitoring. Hemodynamics and blood temperature of all patients were stable during CVVH.

Clinical feature of severe hand, foot and mouth disease with acute pulmonary edema in pediatric patients

To explore the clinical feature of severe hand, foot and mouth disease (HFMD) in pediatric patients, and to observe the hemodynamic changes in those with acute pulmonary edema. A prospective observation study was conducted. Thirty-five severe HFMD pediatric patients with acute pulmonary edema admitted to the intensive care unit (ICU) and Department of Pediatric of First People's Hospital of Foshan from May 2008 to September 2014 were enrolled. The clinical features were thoroughly investigated. Hemodynamic data were monitored by pulse-indicated continuous cardiac output (PiCCO) in 5 cases, and the changes in PiCCO parameters were observed at ICU admission (0 hour), and 24, 48, 96 hours after treatment. Thirty-five patients who met the diagnostic standard of severe HFMD were enrolled, including 22 male and 13 female, aged from 7 months to 4 years. Six patients were younger than 1 year, 13 1-2 years, 12 2-3 years, and 4 patients 3-4 years old. The most common time of occurrence of pulmonary edema was 3-4 days after the onset of the disease. Fever and central nervous system symptoms were found in all the patients, and examination of the cerebral spinal fluid (CSF) revealed non-bacterial inflammatory changes. PiCCO results showed a tendency of lowering of heart rate (HR), systemic vascular resistance index (SVRI), and extravascular lung water index (EVLWI) after the treatment, and the values obtained at 96 hours were significantly lower than those at 0 hour [HR (bpm): 119.0±14.7 vs. 200.8±19.7, SVRI (kPa×s×L(-1)×m(-2)): 148.9±14.6 vs. 209.6±58.7, EVLWI (mL/kg): 10.5±1.9 vs. 34.8±10.8, P<0.05 or P<0.01], global end-diastolic volume index (GEDVI) was also gradually decreased without significant differences among all the time points, together with a tendency of increase in stroke volume index (SI) and cardiac index (CI). The values of the parameters at 96 hours were significantly higher than those at 0 hour [SI (mL/m2): 38.5±6.5 vs. 17.4±2.8, CI (mL×s(-1)×m(-2)): 75.0±8.0 vs. 55.5±8.5, both P<0.01]. Left atrium was found to be enlarged, and left ventricular systolic function decreased in two patients by cardiac ultrasonic. Four out of 35 patients died, and functional disability of extremities was found in 1 patient. Other patients were cured and discharged without any sequelae. Severe HFMD complicated by acute pulmonary edema is a perilous condition in children, accompanied commonly by pathologic changes in central nervous system and systolic dysfunction of left ventricle. According to the results with PiCCO monitoring, HFMD patients suffering from acute pulmonary edema may be of cardiac origin in addition to neurogenic origin.

Value of pulse indicator continuous cardiac output monitoring of cardiac function in septic shock patients: a prospective study

To investigate the value of employing pulse indicator continuous cardiac output ( PiCCO ) for cardiac function monitoring in patients with severe septic shock. A prospective observation was conducted. Thirty-six septic shock patients in Department of Critical Care Medicine of Peking University Third Hospital admitted from August 2011 to December 2013 were enrolled. According to the degree of severity, the patients were divided into PiCCO monitor group and routine monitor group. The PiCCO monitor provided a continuous assessment of fluid resuscitation, vasopressors and inotropes infusion in the patients with severe septic shock. The following cardiac function parameters were assessed in severe septic shock patients on the 1st and 3rd day after intensive care unit ( ICU ) admission: cardiac index ( CI ), global ejection fraction ( GEF ), rate of left ventricular pressure increase ( dp/dt max ), echocardiography, and blood troponin T ( TNT ) and B-type natriuretic peptide ( BNP ). The central venous pressure ( CVP ), mean arterial pressure ( MAP ) and the time reaching their standard values, and the norepinephrine dosage and 3-day fluid balance in severe septic shock patients were compared between milrinone and non-milrinone usage groups. The severity degree and outcome were compared between PiCCO monitor group and routine monitor group. There were 15 patients in PiCCO monitor group and 21 in routine monitor group among 36 septic shock patients. (1) In 15 patients with PiCCO monitoring, the patients with decreased CI, GEF, and dp/dt max accounted for 40.0%, 93.3%, and 33.3% at 1 day after ICU admission, and accounted for 60.0%, 93.3%, and 60.0% at 3 days after ICU admission, and it showed that CI, GEF, and dp/dt max was not improved at 3 days after ICU admission. Echocardiography showed that 35.7% patients had lower left ventricular ejection fraction ( LVEF ) at 1 day after ICU admission, 71.4% and 71.4% of patients, respectively, had lower early diastolic mitral flow velocity/early diastolic myocardial velocity ( E/Em ) and early diastolic mitral flow velocity/end diastolic mitral flow velocity ( E/A ). Three days after ICU admission, 80% of patients with low LVEF value turned to normal, and diastolic dysfunction was ameliorated in 50% patients. At 1 day after ICU admission, higher TNT was found in 92.9% of patients, higher BNP in 100% of patients, and 3 days after ICU admission, 71.4% and 78.6% patients showed a decrease in TNT and BNP, respectively. (2) In PiCCO monitor group, there were no significant differences in initial CVP, MAP and their time reaching standard values, norepinephrine dosage between milrinone group ( n = 8 ) and non-milrinone group ( n = 7 ). However, 3-day intake of liquid in milrinone group was significantly higher than that in non-milrinone group ( mL: 8 324±3 962 vs. 4 372±2 081, t = -2.362, P = 0.034 ). (3) Compared with routine monitor group, there was a significant elevation in acute physiology and chronic health evaluation II ( APACHEII) score, sequential organ failure assessment ( SOFA ) score, duration of mechanical ventilation, length of ICU stay and 28-day hospital mortality in PiCCO monitor group [ APACHEII score: 20.67±6.15 vs. 14.71±4.67, t = -3.304, P = 0.002; SOFA score: 9.53±3.00 vs. 7.52±1.97, t = -2.433, P = 0.020; duration of mechanical ventilation ( hours ): 132 ( 54-310 ) vs. 63 ( 14-284 ), Z = -2.295, P = 0.022; length of ICU stay ( days ): 7 ( 4-15 ) vs. 5 ( 1-14 ), Z = -2.360, P = 0.018; 28-day hospital mortality: 26.7% vs. 0, P = 0.023 ]. With the use of the PiCCO hemodynamic monitoring in patients with severe septic shock, more comprehensive values of blood volume, systemic vascular resistance and cardiac function can be obtained for guiding fluid resuscitation and selection of vasopressor and inotropic drugs.

Early predictive value of hemodynamic parameters during fluid resuscitation in patients with sepsis shock

To investigate the short term predictive value of hemodynamic parameters during fluid resuscitation in patients with septic shock. Data of 76 patients with septic shock admitted to Department of Critical Care Medicine of Beijing Shijitan Hospital from January 2013 to October 2014 were retrospectively analyzed. The hemodynamic parameters were monitored by pulse indicator continuous cardiac output ( PiCCO ), including mean arterial pressure ( MAP ), stroke volume index ( SVI ), cardiac index ( CI ), global ejection fraction ( GEF ), global end diastolic volume index ( GEDVI ), intrathoracic blood volume index ( ITBVI ), extravascular lung water index ( EVLWI ), systemic vascular resistance index ( SVRI ), and pulmonary vascular permeability index ( PVPI ). They were recorded before and 6 hours after fluid resuscitation. According to the prognosis on the 7th day, the patients were divided into survival group ( n = 42 ) and death group ( n = 34 ). The PiCCO records between two groups were compared and a receiver operating characteristic ( ROC ) curve for predicting the outcome was plotted to find the cut-off point value for each PiCCO record before and 6 hours after fluid resuscitation.The factors for predicting 7-day prognosis of patients with septic shock were analyzed by multivariate logistic regression analysis. (1) Compared with those before fluid resuscitation, EVLWI and PVPI were significantly decreased at 6 hours after fluid resuscitation in the survival group [ EVLWI ( mL/kg ): 7.33±1.72 vs. 9.07±2.81, PVPI: 1.39±0.34 vs. 1.74±0.50, both P<0.01 ] but they were significantly increased in the death group [ EVLWI ( mL/kg ): 12.62±3.58 vs. 8.97±2.74, PVPI: 2.36±0.81 vs. 1.73±0.60, both P<0.01 ], and MAP in the death group decreased after fluid resuscitation [ MAP ( mmHg, 1 mmHg = 0.133 kPa ): 70.53±12.12 vs. 77.06±13.48, P<0.01 ]. (2)ROC curve showed that the area under ROC curve ( AUC ) of EVLWI at 6 hours after fluid resuscitation was 0.914, cut-off value was 9.50 mL/kg, the sensitivity was 82.4% and the specificity was 88.1%. The AUC of PVPI was 0.890, when cut-off value was 1.75, the sensitivity was 73.5%, and the specificity was 92.9%. (3) It was shown by multivariate logistic regression analysis that only EVLWI at 6 hours after fluid resuscitation was an independent predictor for 7-day prognosis of septic patient [ odds ratio ( OR ) = 0.546, 95% confidence interval ( 95%CI ) = 0.852-0.976, P = 0.006 ]. PiCCO monitoring indicators such as EVLWI, PVPI and MAP have certain prognostic value for septic patients, but only EVLWI at 6 hours after fluid resuscitation is an independent prognostic factor for short term prognosis.

Pulse indicator continuous cardiac output measurement-guided treatment aids two pediatric patients with severe acute pancreatitis complicated with acute respiratory distress syndrome

To evaluate the clinical value of the pulse indicator continuous cardiac output (PiCCO) system in patients with severe acute pancreatitis (SAP) complicated with acute respiratory distress syndrome (ARDS). Two cases of SAP with ARDS were monitored using PiCCO during comprehensive management in the Pediatric Intensive Care Unit (PICU) of Shengjing Hospital, China Medical University. To guide fluid management, the cardiac index (CI) was measured to assess cardiac function, the global end-diastolic volume index (GEDVI) was used to evaluate cardiac preload, and the extravascular lung water index (EVLWI) was used to evaluate the pulmonary edema. Case 1 was diagnosed with type L2 acute lymphoblastic leukemia (intermediate risk) and received the sixth maintenance phases of chemotherapy this time. After a 1-week dosage of chemotherapeutic drugs (pegaspargase and mitoxantrone), he suffered SAP combined with ARDS. Except comprehensive treatment (life supporting, antibiotic, etc.) and applying continuous veno-venous hemodiafiltration (CVVHDF) to remove inflammatory mediators. PiCCO monitor was utilized to guide fluid management. During the early stage of PiCCO monitoring, the patient showed no significant manifestations of pulmonary edema in the bedside chest X-ray (bedside ultrasound showed left pleural effusion), and had an oxygenation index 223 mmHg (1 mmHg = 0.133 kPa), GEDVI 450 ml/m², and ELVWI 7 ml/kg. We increased cardiac output to increase tissue perfusion and dehydration speed of CVVHDF was set at 70 ml/h. Two hours later, GEDVI significantly increased to 600 ml/m² and ELVWI significantly increased to 10 ml/kg, the oxygenation index declined to 155 mmHg, the bedside chest X-ray showed a significant decrease of permeability (right lung) and PEEP was adjusted to 5 cmH₂O (1 cmH₂O = 0.098 kPa), indicating circulating overload. ARDS subsequently occurred, upon which the fluid infusion was halted, the dehydration rate of CVVHDF raised (adjusted to 100-200 ml/h). On day 3 in the PICU, EVLWI dropped to 6 ml/kg, GEDVI dropped to 370 ml/m², and the oxygenation index increased to 180 mmHg. On day 8, the patient was successfully weaned from the ventilator. However, on day 9, the patient reverted to mechanical ventilation due to secondary infection. On day 30, the patient was discharged for voluntarily giving up treatment. Late follow-up results showed that the patient was dead one day after giving up treatment. Case 2 was admitted due to SAP induced by overeating one day before admission. On day 2, the patient showed dyspnea and oxygen saturation decreased to 80%. We applied mechanical ventilation, CVVHDF to remove inflammatory mediators and PiCCO to guide fluid management. According to the initial data of PiCCO, EVLWI was 9 ml/kg, GEDVI was 519 ml/m², the oxygenation index was 298 mmHg, the bedside chest X-ray showed decreased permeability and PEEP was adjusted to 5 cmH₂O, suggesting the existence of ARDS. During treatment, the dehydration speed of CVVHDF was set at 50 ml/h to maintain the balance of fluid input and output. Two hours after PiCCO monitoring, the oxygenation index decreased to 140 mmHg, GEDVI 481 ml/m², EVLWI 9 ml/kg, thus the dehydration speed of CVVHDF was increased (up to 100 ml/h). On day 4 in the PICU, EVLWI was 9 ml/kg, GEDVI was 430 ml/m², oxygenation index was 394 mmHg, and the bedside chest X-ray showed that permeability was higher. On day 5, the patient was transferred from PiCCO. On day 30, the patient recovered and was discharged. PiCCO monitoring can provide real-time surveillance of cardiac function, cardiac preload and afterload, and extravascular lung water in pediatric patients with SAP combined with ARDS. These results are clinically significant for the rescue of critically ill patients with ARDS or shock.

Evaluation of high volume hemofiltration according to pulse-indicated continuous cardiac output on patients with acute respiratory distress syndrome

To study the effects of high volume hemofiltration (HVHF) according to pulse-indicated continuous cardiac output (PiCCO) on patients with acute respiratory distress syndrome (ARDS). A prospective randomly controlled trial was conducted. 163 patients with ARDS admitted to Taizhou People's Hospital, Medical College, Nantong University, between February 2011 and January 2014, were enrolled. The patients were randomly divided into conventional therapy group (n=50), HVHF group (n=55), and PiCCO + HVHF group (n=58) by random number table. The patients in conventional therapy group received routine treatment including mechanical ventilation and drug treatment according to ARDS treatment guideline. The patients in the HVHF group received HVHF treatment of 18 hours per day on 1, 3, 5, 7 days on the basis of conventional therapy. Patients in the PiCCO + HVHF group received HVHF treatment according to PiCCO. The indexes of lung function and PiCCO monitoring were recorded at intensive care unit (ICU) admission (before) and 4 days and 7 days after treatment. The serum levels of tumor necrosis factor-α (TNF-α) and interleukin-1β (IL-1β) were determined by enzyme linked immunosorbent assay (ELISA), and the prognosis of patients was recorded. In three groups, oxygenation index (PaO₂/FiO₂), static lung compliance (Cs) were gradually increased, and respiratory rate (RR), lactic acid (Lac) were gradually decreased. The indicators in HVHF and PiCCO + HVHF groups were significantly improved compared with conventional therapy group. The indexes in PiCCO + HVHF group were significantly increased or decreased compared with those in HVHF group, and the statistical differences were found on the 7th day after treatment [PaO₂/FiO₂(mmHg, 1 mmHg=0.133 kPa): 189.3 ± 36.8 vs. 166.3 ± 36.1, Cs (mL/cmH₂O): 76.7 ± 18.9 vs. 67.0 ± 18.2, RR (times/min): 16.4 ± 5.2 vs. 19.2 ± 5.4, Lac (mmol/L): 1.20 ± 0.41 vs. 1.41 ± 0.43, all P<0.01]. In PiCCO + HVHF group, cardiac index (CI) was gradually increased, and extra vascular lung water index (EVLWI) and intra thoracic blood volume index (ITBVI) were gradually decreased. There were significant differences in the indexes 4 days and 7 days after treatment compared with those before treatment [CI (L × min⁻¹ m⁻²): 4.62 ± 1.13, 4.83 ± 1.10 vs. 4.01 ± 1.02, EVLWI (mL/kg): 7.6 ± 2.7, 6.5 ± 2.6 vs. 12.4 ± 2.9, ITBVI (mL/m²): 801.3 ± 120.9, 785.4 ± 118.7 vs. 980.1 ± 168.6, all P<0.01]. After treatment, the serum levels of TNF-α and IL-1β in three groups were gradually decreased. Compared with the conventional therapy group, the serum levels of TNF-α and IL-1β on 4 days and 7 days in the HVHF and PiCCO + HVHF groups were significantly decreased, and the statistical differences were found on 7 days [TNF-α (ng/L): 68.35 ± 12.63, 67.54 ± 12.90 vs. 85.35 ± 13.70; IL-1β (ng/L): 424.6 ± 142.9, 412.2 ± 140.2 vs. 895.2 ± 187.7, all P<0.01]. Compared with the HVHF group, the serum levels of TNF-α and IL-1β in the PiCCO + HVHF group were slightly decreased without statistical differences. Compared with the conventional therapy group, the number of organ failure, duration of mechanical ventilation, the length of stay in ICU and hospital mortality in HVHF group and PiCCO + HVHF group were lowered, and the statistical differences were found in PiCCO + HVHF group compared with HVHF group [number of organ failure: 2.41 ± 0.79 vs. 2.72 ± 0.80, duration of mechanical ventilation (days): 4.8 ± 2.0 vs. 5.7 ± 2.1, the length of stay in ICU (days): 11.5 ± 3.4 vs. 13.1 ± 3.6, hospital mortality: 31.0% (18/58) vs. 41.8% (23/55), all P<0.05]. Levels of inflammatory factors in patients with ARDS could be reduced by HVHF. The oxygenation and compliance of lung can be improved, the number of organ failure can be lowered, the duration of mechanical ventilation and the length of stay in ICU can be shortened, and the hospital mortality could be declined by PiCCO guided HVHF.

Study of changes in extravascular lung water index of patients suffered from H7N9 avian influenza with acute respiratory distress syndrome

To analyze the characteristic of changes in extravascular lung water index (EVLWI) of H7N9 avian influenza patients who complicated with acute respiratory distress syndrome (ARDS), and to approach the relevance between EVLWI and severity, pulmonary oxygenation in patients with lung injury. Four H7N9 avian influenza patients administered from April to June in 2013 in First Affiliated Hospital of Nanchang University were studied. The patients who suffered from severe ARDS were administered with low tide volume ventilation plus positive end-expiratory pressure (PEEP), namely protected ventilation strategy, with monitoring hemodynamic parameters and EVLWI through pulse-indicated continuous cardiac output (PiCCO) catheter. During ventilation, patients' parameters, such as PEEP, fraction of inspired oxygen (FiO2), arterial partial pressure of oxygen (PaO2), oxygenation index (PaO2/FiO2), cardiac index (CI), systemic vascular resistance index (SVRI), pulmonary vascular resistance index (PVRI), EVLWI, and central venous pressure (CVP) were collected. All 4 H7N9 avian influenza patients were complicated with ARDS, 2 patients were classified to severe ARDS and administered with comprehensive therapies, specially protected ventilation strategy; ventilation duration was 9 days and 30 days respectively, and PiCCO monitoring was 9 days and 21 days respectively. EVLWI of 2 patients on the 1st, 2nd, 3rd day was 10.0±3.2 ml/kg, 12.0±2.9 ml/kg, 14.0±4.2 ml/kg, and 24.0±6.7 ml/kg, 24.0±6.1 ml/kg, 23.0±5.8 ml/kg, respectively. As their conditions became better, patients' EVLWI decreased to 5.5±2.7 ml/kg and 7.0±3.0 ml/kg, respectively at weaning. PEEP and FiO2 of 2 patients were down-regulated, PaO2/FiO2 increased to 334±64 mm Hg and 142±53 mm Hg at weaning. However, no significant changes in CI, SVRI, PVRI and CVP in the 2 patients were observed. EVLWI increases when H7N9 avian influenza patients are complicated with severe ARDS. As the conditions get better, EVLWI returns to normal value gradually. There is relevance between the motive changes in EVLWI and severity of ARDS and pulmonary oxygenation.

Effects of central venous pressure on acute kidney injury in septic shock

To investigate the effects of central venous pressure on acute kidney injury (AKI) in septic shock. A total of 86 septic shock patients with PiCCO (pulse indicator continuous cardiac output) monitoring admitted at our department from January 2009 to January 2011 were retrospectively studied. They were divided into 2 groups based on central venous pressure (CVP) at 24 hs after PiCCO monitoring. There were 41 cases in low CVP group (CVP ≤ 10 mm Hg and 45 cases in high CVP group (CVP > 10 mm Hg). Their hemodynamic data, lactate concentration, ScvO₂ (central venous oxygen saturation), APACHEII (acute physiology & chronic health evaluation II) score and serum creatinine were obtained at the beginning and 24 hours after PiCCO monitoring. The incidence and mortality of AKI, the outcome of these patients in ICU and at Day 28 post-diagnosis were recorded. (1) The incidences of AKI were 51.2% (21/41) and 75.6% (34/45) in low and high CVP groups respectively; (2) Nine cases (22.0%) died in ICU in low CVP group and 20 cases (44.4%) in high CVP group. And 12 cases (29.3%) died within 28 days in low CVP group while 21 cases (46.7%) in high CVP group. A high CVP may increase the incidence and morbidity of AKI in septic shock. And an excessively high CVP should be prevented.