Clinical application of inferior vena cava inspiratory collapsibility in early goal-directed therapy of septic shock_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

 QI Bo , YANG Wenbin , ZHANG He , LI Guozhi , CAI Jiajun , ZHANG Xizhu , JIANG Fei

903 Hospital, Jiangyou, Sichuan 621700, P. R. China;

Corresponding?author：

QI Bo, Email: 674660470@qq.com

Keywords：

Septic shock; Sepsis; Fluid therapy; Echocardiography; Early goal-directed therapy; Randomized controlled trial

DOI：

10.7507/1671-6205.201906018

Video：

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Abstract Full text Figures/Tables Video References Cited by

Objective To explore the value of inferior vena cava inspiratory collapsibility (ΔIVC) in guiding septic shock resuscitation with early goal-directed therapy (EGDT).Methods A single center, randomized controlled trial was conducted at an 812-bed hospital in Mianyang, Sichuan. Adult patients with early septic shock in the intensive care unit were assessed and treated at defined intervals over 6 h using an ΔIVC-guided resuscitation protocol or an EGDT protocol. Feasibility outcomes were fluid balance and norepinephrine administration. The primary clinical outcomes were in-hospital mortality rate, 90-day survival rate. Secondary outcomes included incidence of acute kidney injury and consumption of health resources.Results Sixty-eight patients with septic shock were enrolled in this study. Baseline characteristics were similar between the two groups. The ΔIVC-guided septic shock resuscitation group was lower than the EGDT group in the ICU 24 h fluid replacement (L): 3.8 (4.0, 5.3) vs. 4.7 (4.0, 6.6), 72 h liquid positive balance (L): 0.2 (–0.65, 1.2) vs. 2.5 (0.0, 4.1), intensive care unit length of stay (d): 7.5 (5.0, 14.0) vs. 15.0 (7.0, 21.5), mechanical ventilation cumulative time (d): 3.0 (0.0, 7.0) vs. 7.5 (2.2, 12.0), ICU costs (ten thousand yuan): 3.4 (2.1, 5.9) vs. 8.6 (4.2, 16.5), bedside blood purification treatment costs (ten thousand yuan): 2.3 (1.1, 3.3) vs. 6.8 (2.1, 10.0) (P<0.05). No difference was observed in the incidence of acute kidney injury (P > 0.05), in-hospital mortality and 90-day survival between the two groups (log-rank χ²=0.35, P>0.05).Conclusions Among patients with septic shock, a ΔIVC-guided septic shock resuscitation, compared with EGDT, did not reduce in-hospital mortality. It might prevent the risk of over resuscitation, shorten the duration of mechanical ventilation, and lead to a better utilization of intensive care unit resources.

Citation： QI Bo, YANG Wenbin, ZHANG He, LI Guozhi, CAI Jiajun, ZHANG Xizhu, JIANG Fei. Clinical application of inferior vena cava inspiratory collapsibility in early goal-directed therapy of septic shock. Chinese Journal of Respiratory and Critical Care Medicine, 2020, 19(3): 246-250. doi: 10.7507/1671-6205.201906018 Copy

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2.	Kelm DJ, Perrin JT, Cartin-Ceba R, et al. Fluid overload in patients with severe sepsis and septic shock treated with early goal-directed therapy is associated with increased acute need for fluid-related medical interventions and hospital death. Shock, 2015, 43(1): 68-73.
3.	Schindler AW, Marx G. Evidence-based fluid management in the ICU. Curr Opin Anaesthesiol, 2016, 29(2): 158-165.
4.	Coen D, Cortellaro F, Pasini S, et al. Towards a less invasive approach to the early goal-directed treatment of septic shock in the ED. Am J Emerg Med, 2014, 32(6): 563-568.
5.	王小亭, 劉大為, 于凱江, 等. 中國重癥超聲專家共識. 中華內科雜志, 2016, 55(11): 900-912.
6.	Singer M, Deutschman CS, Seymour CW, et al. The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA, 2016, 315(8): 801-810.
7.	Rivers E, Nguyen B, Havstad S, et al. Early goal-directed therapy in the treatment of severe sepsis and septic shock. N Engl J Med, 2001, 345(19): 1368-1377.
8.	Mikkelsen ME, Gaieski DF, Goyal M, et al. Factors associated with nonadherence to early goal-directed therapy in the ED. Chest, 2010, 138(3): 551-558.
9.	El Khuri C, Abou Dagher G, Chami A, et al. The impact of EGDT on sepsis mortality in a single tertiary care center in Lebanon. Emerg Med Int, 2019, 2019: 8747282.
10.	Mouncey PR, Osborn TM, Power GS, et al. Trial of early, goal-directed resuscitation for septic shock. N Engl J Med, 2015, 372(14): 1301-1311.
11.	PRISM Investigators, Rowan KM, Angus DC, Bailey M, et al. Early, goal-directed therapy for septic shock - a patient-level meta-analysis. N Engl J Med, 2017, 376(23): 2223-2234.
12.	Yealy DM, Kellum JA, Huang DT, et al. A randomized trial of protocol-based care for early septic shock. N Engl J Med, 2014, 370(18): 1683-1693.
13.	Peake SL, Delaney A, Bailey M, et al. Goal-directed resuscitation for patients with early septic shock. N Engl J Med, 2014, 371(16): 1496-1506.
14.	Kaukonen K, Bailey M, Suzuki S, et al. Mortality related to severe sepsis and septic shock among critically ill patients in Australia and New Zealand, 2000-2012. JAMA, 2014, 311(13): 1308-1316.
15.	Martin GS, Mannino DM, Eaton S, et al. The epidemiology of sepsis in the United States from 1979 through 2000. N Engl J Med, 2003, 348(16): 1546-1554.
16.	Vieillardbaron A, Chergui K, Rabiller A, et al. Superior vena caval collapsibility as a gauge of volume status in ventilated septic patients. Intensive Care Med, 2004, 30(9): 1734-1739.

1. Gotts JE, Matthay MA. Sepsis: pathophysiology and clinical management. BMJ, 2016, 353: i1585.
2. Kelm DJ, Perrin JT, Cartin-Ceba R, et al. Fluid overload in patients with severe sepsis and septic shock treated with early goal-directed therapy is associated with increased acute need for fluid-related medical interventions and hospital death. Shock, 2015, 43(1): 68-73.
3. Schindler AW, Marx G. Evidence-based fluid management in the ICU. Curr Opin Anaesthesiol, 2016, 29(2): 158-165.
4. Coen D, Cortellaro F, Pasini S, et al. Towards a less invasive approach to the early goal-directed treatment of septic shock in the ED. Am J Emerg Med, 2014, 32(6): 563-568.
5. 王小亭, 劉大為, 于凱江, 等. 中國重癥超聲專家共識. 中華內科雜志, 2016, 55(11): 900-912.
6. Singer M, Deutschman CS, Seymour CW, et al. The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA, 2016, 315(8): 801-810.
7. Rivers E, Nguyen B, Havstad S, et al. Early goal-directed therapy in the treatment of severe sepsis and septic shock. N Engl J Med, 2001, 345(19): 1368-1377.
8. Mikkelsen ME, Gaieski DF, Goyal M, et al. Factors associated with nonadherence to early goal-directed therapy in the ED. Chest, 2010, 138(3): 551-558.
9. El Khuri C, Abou Dagher G, Chami A, et al. The impact of EGDT on sepsis mortality in a single tertiary care center in Lebanon. Emerg Med Int, 2019, 2019: 8747282.
10. Mouncey PR, Osborn TM, Power GS, et al. Trial of early, goal-directed resuscitation for septic shock. N Engl J Med, 2015, 372(14): 1301-1311.
11. PRISM Investigators, Rowan KM, Angus DC, Bailey M, et al. Early, goal-directed therapy for septic shock - a patient-level meta-analysis. N Engl J Med, 2017, 376(23): 2223-2234.
12. Yealy DM, Kellum JA, Huang DT, et al. A randomized trial of protocol-based care for early septic shock. N Engl J Med, 2014, 370(18): 1683-1693.
13. Peake SL, Delaney A, Bailey M, et al. Goal-directed resuscitation for patients with early septic shock. N Engl J Med, 2014, 371(16): 1496-1506.
14. Kaukonen K, Bailey M, Suzuki S, et al. Mortality related to severe sepsis and septic shock among critically ill patients in Australia and New Zealand, 2000-2012. JAMA, 2014, 311(13): 1308-1316.
15. Martin GS, Mannino DM, Eaton S, et al. The epidemiology of sepsis in the United States from 1979 through 2000. N Engl J Med, 2003, 348(16): 1546-1554.
16. Vieillardbaron A, Chergui K, Rabiller A, et al. Superior vena caval collapsibility as a gauge of volume status in ventilated septic patients. Intensive Care Med, 2004, 30(9): 1734-1739.

Chinese Journal of Respiratory and Critical Care Medicine

Clinical application of inferior vena cava inspiratory collapsibility in early goal-directed therapy of septic shock

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