1 Introduction
2 Patients and methods
2.1 Patients
2.2 Protocol
2.3 Statistical analysis
3 Results
3.1 Baseline characteristics
Responders (n = 19) | Non-responders (n = 16) |
P
| |
---|---|---|---|
Age, year | 69 [55–78] | 66 [57–73] | 0.46 |
Sex, male | 11 (58) | 10 (63) | 0.78 |
Female | 8 (42) | 6 (37) | |
BMI (kg/m2) | 24.7 [22.5–29] | 24.2 [20–27.3] | 0.22 |
Premorbidity | |||
Cardiovascular | 11 (58) | 11 (69) | 0.51 |
Liver disease | 1 (5) | 3 (19) | 0.21 |
Malignancy | 6 (32) | 5 (31) | 0.98 |
Source of sepsis | |||
Abdominal | 7 (37) | 8 (50) | 0.43 |
Respiratory | 8 (42) | 5 (31) | 0.51 |
Other | 4 (21) | 3 (19) | 0.86 |
Bacteraemia | 12 (63) | 10 (63) | 0.97 |
Time since admission (h) | 24 [5–60] | 48 [16–144] | 0.16 |
APACHE II | 28 [20–32] | 24 [18–27] | 0.08 |
SOFA | 11 [7–14] | 11 [8–12] | 0.81 |
Mechanical ventilation | 19 (100) | 13 (81) | 0.05 |
Vasopressor support | 13 (68) | 12 (75) | 0.67 |
NE (µg kg−1 min−1) | 0.06 [0–0.3] | 0.18 [0–0.37] | 0.55 |
Prior fluid balance (mL) | 4,838 [2,921–10,216] | 7,281 [2,725–9,537] | 0.74 |
Survival | 9 (47) | 10 (63) | 0.37 |
Responders (n = 19) | Non-responders (n = 16) | |||||
---|---|---|---|---|---|---|
Before | After |
P
| Before | After |
P
| |
Heart rate (bpm) | 89 [78–100] | 92 [71–105] | 0.18 | 96 [82–106] | 95 [80–105] | 0.046 |
Stroke volume (mL) | 70 [45–87] | 78 [56–97] | na | 82 [65–116] | 78 [64–110] | na |
Cardiac output (L/min) | 5.8 [5.2–7.6]* | 7.0 [6.0–8.1] | <0.001 | 7.3 [6.6–9.9] | 7.1 [6.0–8.6] | 0.009 |
Cardiac index (L/min/m2) | 3.3 [2.4–3.7]†
| 3.6 [3.1–4.4] | <0.001 | 4.0 [3.4–5.1] | 3.9 [3.3–4.4] | 0.009 |
Mean arterial pressure (mmHg) | 72 [64–75] | 75 [70–82] | 0.001 | 74 [68–81] | 76 [69–84] | 0.16 |
Pulse pressure (mmHg) | 64[51–75] | 72 [63–85] | 0.009 | 61 [52–82] | 63 [52–84] | 0.68 |
Microvascular flow index (AU) | 3.3 [2.9–3.8] | 3.9 [3.0–4.0] | 0.007 | 3.2 [3.0–3.7] | 3.6 [3.0–3.8] | 0.20 |
Functional capillary density (mm/mm2) | 15.0 [13.2–17.4] | 16.2 [15.0–17.8] | 0.030 | 16.0 [14.3–16.8] | 15.7 [15.5–18.0] | 0.24 |
Vessel density (mm) | 10.9 [10.3–12.1] | 11.9 [11.4–13.0] | 0.006 | 11.0[10.6–13.1] | 11.6 [11.2–12.7] | 0.09 |
Proportion of perfused vessels (%) | 96 [94–100] | 97 [96–100] | 0.06 | 99 [95–100] | 99 [96–100] | 0.14 |
Laser Doppler flow (AU) | 115 [31–331] | 169 [36–347] | 0.030 | 270 [41–311] | 287 [123–358] | 0.50 |
µHbSO2 (%) | 49 [26–55] | 51 [43–59] | 0.020 | 55 [38–65] | 52 [40–65] | 0.12 |
rHb (AU) | 27 [23–33] | 31 [26–38] | 0.10 | 32 [25–37] | 3 [25–37] | 0.96 |
3.2 Effects of fluid infusion
Responders (n = 15) | Non-responders (n = 20) | |||||
---|---|---|---|---|---|---|
Before | After |
P
| Before | After |
P
| |
Heart rate (bpm) | 89 [78–120] | 89 [71–118] | 0.12 | 98 [82–101] | 97 [80–104] | 0.09 |
Stroke volume (mL) | 59 [43–75]* | 70 [55–97] | na | 82 [68–116] | 82 [66–116] | na |
Cardiac output (L/min) | 5.5 [4.7–6.6]†
| 6.7 [5.9–8.0] | 0.001 | 7.5 [7.0–9.9] | 7.3 [6.5–8.6] | 0.35 |
Cardiac index (L/min/m2) | 2.9 [2.2–3.6]‡
| 3.4 [3.0–4.1] | 0.001 | 4.0 [3.4–5.2] | 3.9 [3.4–4.8] | 0.082 |
Mean arterial pressure (mmHg) | 72 [64–75] | 77 [71–82] | 0.002 | 73 [68–81] | 75 [69–84] | 0.040 |
Pulse pressure (mmHg) | 64 [46–74] | 71 [63–79] | 0.021 | 63 [56–82] | 64 [55–86] | 0.36 |
Microvascular flow index (AU) | 3.2 [2.9–3.8] | 3.9 [3.0–4.0] | 0.006 | 3.2 [3.0–3.8] | 3.5 [3.0–3.8] | 0.24 |
Functional capillary density (mm/mm2) | 15.2 [13.2–17.4] | 16.3 [15.0–17.8] | 0.046 | 15.5 [14.2–17.2] | 15.9 [15.3–18.0] | 0.14 |
Vessel density (mm) | 11.1 [10.3–12.1] | 12.1 [11.4–13.0] | 0.019 | 10.9 [10.5–12.8] | 11.7 [10.9–12.8] | 0.032 |
Proportion of perfused vessels (%) | 97 [94–100] | 98 [97–100] | 0.13 | 98 [93–100] | 99 [95–100] | 0.041 |
Laser Doppler flow (AU) | 216 [31–347] | 278 [36–365] | 0.035 | 203 [41–303] | 221 [51–313] | 0.49 |
µHbSO2 (%) | 51 [34–59] | 54 [47–61] | 0.006 | 52 [20–60] | 51 [22–64] | 0.27 |
rHb (AU) | 27 [21–29] | 31 [26–38] | 0.030 | 32 [25–37] | 33 [25–37] | 0.60 |
AUC ± Std. error P
| Optimal cutoff sens | Spec | PPV | NPV | |||
---|---|---|---|---|---|---|---|
SV ≥ 5 % | |||||||
Delta PP (mmHg) | 0.76 ± 0.09 | 0.003 | 4 | 68 | 88 | 87 | 70 |
Delta MAP (mmHg) | 0.74 ± 0.09 | 0.006 | 6 | 58 | 88 | 85 | 64 |
Delta rHb (AU) | 0.72 ± 0.09 | 0.015 | −0.7 | 44 | 93 | 68 | 73 |
SV ≥ 10 % | |||||||
Delta PP (mmHg) | 0.77 ± 0.09 | 0.004 | 6 | 73 | 90 | 85 | 82 |
Delta MAP (mmHg) | 0.75 ± 0.09 | 0.006 | 6 | 73 | 90 | 85 | 82 |
Delta µHbSO2 (%) | 0.73 ± 0.09 | 0.015 | 2 | 64 | 79 | 69 | 75 |
Delta rHb (AU) | 0.71 ± 0.09 | 0.025 | 1.5 | 50 | 89 | 78 | 71 |
Delta MFI (AU) | 0.69 ± 0.10 | 0.048 | 0 | 71 | 69 | 67 | 73 |