Stroke volume variation guided fluid therapy in septic shock with ARDS

Abstract

Introduction Optimal fluid resuscitation guided by central venous pressure (CVP) in patients having septic shock with ARDS is a perplexed issue having risk of underfilling and worsening of shock versus fluid overload leading to pulmonary edema. Whether stroke volume variation (SVV) (Flotrac-Vigileo system) guided fluid resuscitation has an impact on improvement of shock, oxygenation and mortality were tested in this single-center prospective study [1,2]. Methods Inclusion criteria were: (1) septic shock patients with dose of norepinephrine >0.1 mug/kg/minute or dopamine >10 mug/kg/ minute; (2) CVP >12 mmHg; (3) PO2/FiO 2 ratio <200 with ARDSnet protocol ventilation under deep sedation. Exclusion criteria were atrial/ventricular arrhythmias, spontaneous triggering of inspiration, established renal failure needing continuous renal replacement therapy (CRRT). During the 24-hour study period, SVV was continuously monitored with the third-generation Flotrac-Vigileo system (version 3.02). Intravenous fluids were given in the boluses of 250 to 500 cm3 to keep SVV <12% throughout the study period. Vasopressor infusion was titrated to keep MAP >70 mmHg. Results Thirty-seven patients with severe sepsis-induced multiorgan dysfunction syndrome with average APACHE II score of 24.6 and PEEP of 8.2 cm were enrolled. SVV guided fluids received during the 24-hour (Table presented) study period were 5.1 +/- 2.6 l. Arterial lactates reduced significantly without worsening of hypoxia. The PO2/FiO 2 ratio increased significantly at 24 hours. Twenty-two out of 37 survived (59.45%) until hospital discharge. See Table 1. Conclusion SVV guided fluid therapy in septic shock with ARDS may improve shock by optimizing preload in a targeted way without worsening oxygenation.