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ABSTRACT: To evaluate whether or not brachial artery peak velocity (Vpeak-BA) induced by passive leg raising (PLR) may predict volume responsiveness.
We prospectively studied 29 patients enrolled into our intensive care unit (ICU) with spontaneous breathing during mechanical ventilation. Through echocardiography we compared the changes of brachial artery peak velocity induced by passive leg raising (ΔVBA-PLR) and the changes of left ventricle outflow tract velocity-time integral after volume expansion (ΔVTI-VE). Also the sensitivity and specificity of ΔVpeak-BA were determined in predicting volume responsiveness.
Among them, 15 responded to volume expansion and the rest 14 did not. ΔVBA-PLR and ΔVTI-VE were mutually correlated (R(2) = 0.378, P = 0.011). The sensitivity and specificity of ΔVpeak-BA ≥ 16% to predict volume responsiveness were 73% and 87% respectively.
Brachial artery peak velocity induced by passive leg raising is a reliable indicator of predicting volume responsiveness in patients with spontaneous breathing.
Zhonghua yi xue za zhi 01/2013; 93(3):195-9.
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ABSTRACT: OBJECTIVE: To explore the value of power Doppler ultrasound (PDU) in the evaluation of acute kidney injury(AKI). METHODS: Renal blood flow of 40 AKI cases was monitored by power Doppler ultrasound and 4-level semiquantitative PDU score method employed. All cases were divided into 3 groups by PDU score. AKI stage and duration were compared. And the co-variables of death and (continuous renal replacement therapy) CRRT days (> 3) were also analyzed by Logistic regression analysis. RESULTS: A total of 40 AKI case were recruited. The 3-score group (n = 13)has lower mortality in intensive care unit and at 28 days than the 2-score group (n = 15) and the 1-score group (n = 12). The number of stage-3 AKI in the 3-score group was less than that in the 2-score and 1-score groups (n = 1, 4, 9 correspondingly, χ(2) = 16.103, degree of freedom = 4, P = 0.003). The number of persistent AKI in the 3-score group was less than that in the 2-score and 1-score groups (n = 3, 9, 10 correspondingly, P < 0.05). Age, APACHEII score and PDU score (< 3) were closely correlated with death while age, APACHEII score, level of serum creatinine and PDU score (< 3) with CRRT days (> 3) (P < 0.05). CONCLUSION: PDU may be used to monitor renal hemodynamics in AKI patients and its score helps clinicians to evaluate the severity and prognosis of AKI.
Zhonghua yi xue za zhi 12/2012; 92(47):3354-3357.
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ABSTRACT: OBJECTIVE: To investigate the effect of the bedside lung ultrasound in emergency(BLUE)-plus lung ultrasound protocol on lung consolidation and atelectasis of critical patients. METHODS: All patients who need to receive mechanical ventilation for more than 48 hours in ICU from June 2010 to December 2011 in Peking Union Medical College Hospital were included in the study. BLUE-plus and BLUE lung ultrasound, bedside X-ray, lung CT examination were performed on all patients at the same time. The condition of lung consolidation and atelectasis discovered by BLUE-plus lung ultrasound protocol was recorded and compared with bedside X-ray or lung CT. The difference in assessment of lung consolidation and atelectasis between BLUE-plus lung ultrasound protocol and BLUE protocol was compared. RESULTS: A total of 78 patients were finally enrolled in the study. The lung CT found 70 cases (89.74%) had different degrees of lung consolidation and atelectasis. The sensitivity, specificity and diagnostic accuracy of lung consolidation and atelectasis by the bedside chest X-ray were 31.29%, 75.00% and 38.46%, respectively. BLUE-plus lung ultrasound protocol found 68 cases with lung consolidation and atelectasis, and its sensitivity, specificity, and diagnostic accuracy were 95.71%, 87.50% and 94.87%, respectively, which were significantly higher than those of lung CT. BLUE protocol found 48 cases of lung consolidation and atelectasis, and its sensitivity, specificity, and diagnostic accuracy were 65.71%, 75.00% and 66.67%, respectively. The position of lung consolidation and atelectasis which hadn't been found by BLUE protocol was mainly proved to be located in the basement of lung by lung CT. CONCLUSIONS: The incidence of lung consolidation and atelectasis in critical patients who received mechanical ventilation is high. The BLUE-plus lung ultrasound protocol has a relatively higher sensitivity, specificity and diagnostic accuracy for consolidation and atelectasis, which can find majority of consolidation and atelectasis. As BLUE-plus lung ultrasound is a bedside noninvasive method allowing immediate assessment of most lung consolidation and atelectasis, it will be likely the alternative of the CT and play a key role in assessment of lung consolidation and atelectasis.
Zhonghua nei ke za zhi [Chinese journal of internal medicine] 12/2012; 51(12):948-951.
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ABSTRACT: To explore the role of left ventricular-arterial coupling in the resuscitation of refractory septic shock.
A total of 58 patients with refractory septic shock admitted from January 2010 to July 2011 were retrospectively studied. Hemodynamic data, arterial lactate concentration and APACHEII (acute physiology & chronic health evaluation II) score at the beginning of and 24 hours after cardiac output monitoring, as well as the outcome of Day 28 post-diagnosis were recorded. Stroke volume index (SVI), cardiac index (CI) and global end diastolic volume index (GEDVI) were obtained through transpulmonary thermodilution technique by a pulse induced continuous cardiac output (PiCCO) system. Left ventricular end systolic volume index (LVESVI) was approximated to (GEDVI/4-SVI) while effective arterial elastance index/ventricular end systolic elastance index (EaI/EesI) was approximated to LVESVI/SVI.
(1) APACHEII score at the 24th hour, 24 hs lactate clearance rate and 24 hs Ea/Ees variation (ΔEa/Ees) were higher in non-survivors than those in survivors; (2) binary Logistic regression analysis showed that ΔEa/Ees and APACHEII score at the 24th hour were the independent risk factors of mortality for refractory septic shock. And the OR value of ΔEa/Ees was higher than that of APACHEII score (2.04 vs 1.63). Their areas of ROC curve were 0.705 (95%CI 0.569 - 0.841, P = 0.007) and 0.939 (95%CI 0.878 - 1.000, P = 0.000) respectively; (3) all hemodynamic parameters at the beginning had no difference between ΔEa/Ees > 0 and ΔEa/Ees ≤ 0 groups. CI, SVI, EGDT (early goal-directed therapy) compliance rate at the 24th hour in the ΔEa/Ees > 0 group were lower than those in the ΔEa/Ees ≤ 0 group. The effective arterial elastance index (EaI) at the 24th hour and the mortality rate of Day 28 in the ΔEa/Ees > 0 group were higher than those in the ΔEa/Ees ≤ 0 group; (4) during the 24 hs treatment, ΔEa/Ees was correlated negatively with the variations of CI, SVI, EesI and lactate clearance rate and positively with the variations of heart rate, GEDVI, systolic vascular resistance index and EaI.
ΔEa/Ees may be used as an excellent marker of predicting the outcome of refractory septic shock. Lowing Ea/Ees in resuscitation has beneficial effects on EGDT compliance, lactate clearance and outcome.
Zhonghua yi xue za zhi 04/2012; 92(15):1012-6.
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ABSTRACT: To assess the value of procalcitonin (PCT) measurement to differentiate infection from non-infection in critically ill patients requiring long-term immunosuppressive therapy.
A prospective study was conducted in patients with underlying diseases requiring corticosteroids or chemotherapy in ICU from January 2008 to December 2009. Patients were divided into the infection group and the non-infection group and their PCT levels were compared.
A total of 103 patients (65 women) were enrolled in this prospective study [aged (47.9 ± 21.9) years old] with 84 in the infection group and 19 in the non-infection group. The baseline level of PCT was significantly higher in infection than in non-infection patients [2.58 (0.08 - 44.65) pg/L vs 0.62 (0.15 - 6.00) pg/L, P = 0.002]. Different levels of PCT were manifested in different pathogen groups with 3.41 (0.45 - 44.65) pg/L in bacteria infection, 0.99 (0.28 - 6.67) pg/L in fungus infection, 0.11 (0.08 - 0.20) pg/L in virus infection group (P = 0.018). The AUC(ROC) of PCT was 0.867 for diagnostic bacterial infection. By multivariate analysis, the factors associated with the level of PCT were bacteria infection (OR 5.1, P = 0.031) and septic shock (OR 7.5, P = 0.027), while the factors not associated with the level of PCT were age, renal function, infection site and prognosis (P > 0.05).
The level of PCT is increased in the critically ill patients requiring immunosuppressive therapy with infection and it can be used for diagnosis for bacterial infection.
Zhonghua nei ke za zhi [Chinese journal of internal medicine] 03/2012; 51(3):192-6.
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ABSTRACT: To investigate the impact of extended focus assessed transthoracic echocardiography (eFATE) in septic shock patients.
A total of 83 septic shock patients were recruited. And they were divided into the eFATE and routine groups. In the routine group, the patients were assessed by routine methods. And in the eFATE group, the following parameters of central venous pressure (CVP), mean arterial pressure (MAP), cardiac index (CI), stroke volume index (SVI) and ScvO(2) (central venous oxygen saturation) were measured routinely. The PiCCO (pulse indicator continuous cardiac output) method was employed when needed. All parameters and the others [acute physiology and chronic health evaluation II (APACHEII) & lactate] were recorded every 6 h. At 6, 24, 72 h and 1 w, the fluid intake volumes were recorded. All values were analyzed by statistic methods. And the mortality rates of intensive care unit and Day 28 were recorded.
In the eFATE group, the 24 h targeting rate was markedly higher than the routine group. Yet there was no effect on the 6 h targeting rate. In the eFATE group, the fluid intake volumes at 6, 24 h and 1 w were markedly lowered than those of the control group. And the myocardial inhibition occurred earlier versus the control group. There was no difference in mortality rate between two groups.
eFATE plays an important role in the correct assessment of septic shock patients. But its prognostic impact remains to be further defined.
Zhonghua yi xue za zhi 07/2011; 91(27):1879-83.
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ABSTRACT: 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.
Zhonghua yi xue za zhi 05/2011; 91(19):1323-7.
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ABSTRACT: To evaluate fluid responsiveness by stroke volume variation(SVV) in mechanically ventilated patients with refractory septic shock.
Forty-two refractory septic shock patients were enrolled in the study. According to the responsiveness of fluid loading, the patients were divided into responsive group and non-responsive group. The SVV values of two groups were retrospectively analyzed. The receiver operating characteristic curve was drafted to determine the cut-off value of SVV for predicting fluid responsiveness.
Among the 42 refractory septic shock patients, 24 were found responsive to fluid loading, 18 were not; before the fluid loading, central venous pressure, heart rate, mean arterial pressure and global end-diastolic volume index in the both groups showed no significant differences whereas the SVV in the responsive group was much higher than that in the nonresponsive group (P=0.006). Using SVV≥12% as the threshold to predict fluid responsiveness, the sensitivity was 77%, specificity was 85%.
SVV can accurately predict fluid responsiveness in refractory septic shock patients.
Zhonghua nei ke za zhi [Chinese journal of internal medicine] 07/2010; 49(7):610-3.
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ABSTRACT: To investigate the characteristics and influence of cardiac depression on patients with septic shock.
Seventy seven septic shock patients treated from January 2005 to June 2009 were retrospectively studied, they were divided into two groups based on cardiac index (CI) after early resuscitation, high CI group: CI >/= 3 L/(min.m(2)), low CI group: CI < 3 L/(min.m(2)). Rate of goal achievement, prognosis and whether the global end diastolic volume index (GEDI) increases with central venous pressure (CVP) growth of the two groups were compared.
There were 38 patients in the low CI group, and 39 patients in the high CI group. Compared with patients in the high CI group, patients in the low CI group had older age and higher APACHE II score (P < 0.05). Compared with patients in the high CI group, patients in the low CI group had higher mortality rate and lower rate of goal achievement (P < 0.05). In low CI group, 16 patients' GEDI didn't increase with CVP growth, and in high CI group only 6 patients' GEDI didn't increase with CVP growth (P < 0.05); In low CI group, patients whose GEDI didn't increase with CVP growth had higher arterial lactate, lower ScvO(2), lower rate of goal achievement and worse prognosis than patients whose GEDI increased with CVP growth(P < 0.05).
For septic shock patients, correlation between CVP and GEDI can reflect cardiac function. Especially for patients with low CI, GEDI doesn't increase with CVP growth is a signal of cardiac depression and can be an early indicator of worse prognosis. Older septic shock patients and those with higher APACHE II score tend to have the complication of cardiac depression.
Zhonghua wai ke za zhi [Chinese journal of surgery] 02/2010; 48(3):201-4.
