RESPIRATORY VARIABILITY OF VALVULAR PEAK SYSTOLIC VELOCITY AS A NEW INDICATOR OF FLUID RESPONSIVENESS IN PATIENTS WITH SEPTIC SHOCK

Author:

Ma Qiang1,Ding Caiyun2,Jiang Feng1,Hu Guobin1,Wu Jingyi3,Zhang Xia1

Affiliation:

1. Department of Ultrasound, The First Affiliated Hospital of Wannan Medical College, Wuhu, Anhui, China

2. Department of Physiology, Wannan Medical College, Wuhu, Anhui, China

3. Department of Emergency Internal Medicine, The First Affiliated Hospital of Wannan Medical College, Wuhu, Anhui, China

Abstract

ABSTRACTObjective:The aim of this study was to evaluate the reliability and feasibility of pulse Doppler measurements of peak velocity respiratory variability of mitral and tricuspid valve rings during systole as new dynamic indicators of fluid responsiveness in patients with septic shock.Methods:Transthoracic echocardiography (TTE) was performed to measure the respiratory variability of aortic velocity-time integral (∆VTI), respiratory variability of tricuspid annulus systolic peak velocity (∆RVS), respiratory variability of mitral annulus systolic peak velocity (∆LVS), and other related indicators. Fluid responsiveness was defined as a 10% increase in cardiac output after fluid expansion, assessed by TTE.Results:A total of 33 patients with septic shock were enrolled in this study. First, there was no significant difference in the population characteristics between the fluid responsiveness positive group (n = 17) and the fluid responsiveness negative group (n = 16) (P> 0.05). Second, Pearson correlation test showed that ∆RVS, ∆LVS, and TAPSE with the relative increase in cardiac output after fluid expansion (R= 0.55,P= 0.001;R= 0.40,P= 0.02;R= 0.36,P= 0.041). Third, multiple logistic regression analysis demonstrated that ∆RVS, ∆LVS, and TAPSE were significantly correlated with fluid responsiveness in patients with septic shock. Fourth, receiver operating characteristic (ROC) curve analysis revealed that ∆VTI, ∆LVS, ∆RVS, and TAPSE had good predictive ability for fluid responsiveness in patients with septic shock. The area under the curve (AUC) of ∆VTI, ∆LVS, ∆RVS, and TAPSE for predicting fluid responsiveness was 0.952, 0.802, 0.822, and 0.713, respectively. The sensitivity (Se) values were 1.00, 0.73, 0.81, and 0.83, whereas the specificity (Sp) values were 0.84, 0.91, 0.76, and 0.67, respectively. The optimal thresholds were 0.128, 0.129, 0.130, and 13.9 mm, respectively.Conclusion:Tissue Doppler ultrasound evaluation of respiratory variability of mitral and tricuspid annular peak systolic velocity could be a feasible and reliable method for the simple assessment of fluid responsiveness in patients with septic shock.

Publisher

Ovid Technologies (Wolters Kluwer Health)

Subject

Critical Care and Intensive Care Medicine,Emergency Medicine

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