Pulse-induced contour cardiac output (PiCCO) combined with passive leg raising test predicting fluid resuscitation in adult patients with septic shock

Publication date: Available online 17 July 2017
Source:The Kaohsiung Journal of Medical Sciences
Author(s): Si-Dong Zhan
To investigate the clinical value of pulse-induced contour cardiac output (PiCCO) monitoring combined with passive leg raising (PLR) test in predicting fluid responsiveness so as to guide fluid resuscitation in adult septic shock patients managed by rehydration test. One hundred and forty five adult septic shock patients, who were informed to receive PLR tests and rehydration tests. Patients were divided into two groups based on the observation of fluid responsiveness in the rehydration test. Parameters including heart rate (HR), central venous pressure (CVP), systolic blood pressure (SAP), mean arterial pressure (MAP), pulse pressure (PP), pulse indicates cardiac index (PCCI), central venous blood saturation in oxygen (ScvO2) and stroke fluid (SV) were monitored. By PLR test, CVP, SAP, MAP, PP, PCCI and ScvO2 were all increased significantly in the responding group; CVP, SAP, MAP, PP, PCCI and ScvO2 were all upregulated in the responding and nonresponding groups after PLR test (all P < 0.05). By rehydration test, CVP, MAP, PCCI, ScvO2 and SV were elevated in the responding group; and CVP, MAP and PCCI improved significantly both in both groups after rehydration test (all P < 0.05). PLR-ΔSV and PLR-ΔPP (PLR induced changes in stroke fluid) were both positively correlated with ΔSV (the rate of change of stroke fluid induced by fluid infusion test) (both P < 0.05). PLR combined with PiCCO may predict the fluid responsiveness in adult patients with septic shock by monitoring PLR-ΔSV associated with PLR-ΔPP, thereby contribute effectively to the guidance of fluid resuscitation.



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