The effect of fluid therapy on hemodynamic and venous blood gas parameters in patients with septic shock

Sahar Mirbaha, Abdelrahman Ibrahim Abushouk, Ahmed Negida, Alaleh Rouhipour, Alireza Baratloo

Abstract


Background: Hemodynamics and venous blood gas (VBG) may be used to guide fluid therapy in septic shock patients. However, the influence of fluid therapy on hemodynamic and blood gas parameters is not fully understood. In this study, we aimed to investigate the effect of fluid therapy on hemodynamic and VBG parameters.

Methods: This cross-sectional study was conducted from January to April 2016. All patients with diagnosis of severe sepsis were enrolled in the study. Systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), central venous pressure (CVP) shock index, VBG parameters, serum sodium (Na) and chloride (Cl) levels, anion gap, and oxygen saturation (O2sat) were assessed before fluid resuscitation, after resuscitation, and after fluid challenge test.

Results: A total of 100 patients were included (mean age were 72.54 ± 12.77 years, 66% male). Fluid therapy significantly increased DBP (df: 2; F= 4.17; p = 0.017), MAP (df: 2; F= 6.06; p= 0.003), and CVP (df: 2; F= 27.54; p < 0.001), while the shock index was significantly reduced After fluid challenge test (df: 2; F= 7.6; p= 0.001). In addition, fluid therapy had no effect on pH (p= 0.90), HCO3 (p= 0.23), base excess (p= 0.13), SCVO2 (p= 0.73), O2sat (p= 0.73), anion gap (p= 0.96), serum Na level (p= 0.71), and serum Cl level (p= 0.64).

Conclusion: Administration of fluid therapy in septic shock patients had no significant effect on SBP, heart rate, or blood gas parameters. Future studies on a larger sample of patients should confirm these findings and correlate them to clinical outcomes.


Keywords


Hemodynamic parameters; Blood Gas Analysis; Fluid Therapy; Shock, Septic

Full Text:

PDF

References


Annane D, Bellissant E, Cavaillon J-M. Septic shock. Lancet. 2005;365(9453):63-78.

Martin GS, Mannino DM, Eaton S, Moss M. The epidemiology of sepsis in the United States from 1979 through 2000. N Engl J Med. 2003;348(16):1546-54.

Frausto MSR, Pittet D, Hwang T, Woolson RF, Wenzel RP. The dynamics of disease progression in sepsis: Markov modeling describing the natural history and the likely impact of effective antisepsis agents. Clin Infect Dis. 1998;27(1):185-90.

Alberti C, Brun-Buisson C, Burchardi H, Martin C, Goodman S, Artigas A, et al. Epidemiology of sepsis and infection in ICU patients from an international multicentre cohort study. Intensive Care Med. 2002;28(2):108-21.

Friedman G, Silva E, Vincent J-L. Has the mortality of septic shock changed with time? Crit Care Med. 1998;26(12):2078-86.

Angus DC, Van der Poll T. Severe sepsis and septic shock. N Engl J Med. 2013;369(9):840-51.

Rivers E, Nguyen B, Havstad S, Ressler J, Muzzin A, Knoblich B, et al. Early goal-directed therapy in the treatment of severe sepsis and septic shock. N Engl J Med. 2001;345(19):1368-77.

Tavernier B, Makhotine O, Lebuffe G, Dupont J, Scherpereel P. Systolic pressure variation as a guide to fluid therapy in patients with sepsis-induced hypotension. Journal of the American Society of Anesthesiologists. 1998;89(6):1313-21.

Kumar A, Anel R, Bunnell E, Habet K, Zanotti S, Marshall S, et al. Pulmonary artery occlusion pressure and central venous pressure fail to predict ventricular filling volume, cardiac performance, or the response to volume infusion in normal subjects. Crit Care Med. 2004;32(3):691-9.

Michard F, Teboul J-L. Predicting fluid responsiveness in ICU patients: a critical analysis of the evidence. CHEST Journal. 2002;121(6):2000-8.

Timsit J-F, Misset Bt, Carlet J, Boyer J-M, Farkas J-C, Martin J-B, et al. Central vein catheter-related thrombosis in intensive care patients: incidence, risks factors, and relationship with catheter-related sepsis. CHEST Journal. 1998;114(1):207-13.

Rady MY, Rivers EP, Nowak RM. Resuscitation of the critically III in the ED: responses of blood pressure, heart rate, shock index, central venous oxygen saturation, and lactate. The American journal of emergency medicine. 1996;14(2):218-25.

Creteur J, Carollo T, Soldati G, Buchele G, De Backer D, Vincent J-L. The prognostic value of muscle StO2 in septic patients. Intensive Care Med. 2007;33(9):1549-56.

Jung J, Eo E, Ahn K, Noh H, Cheon Y. Initial base deficit as predictors for mortality and transfusion requirement in the severe pediatric trauma except brain injury. Pediatr Emerg Care. 2009;25(9):579-81.

Baratloo A, Rahmati F, Rouhipour A, Motamedi M, Gheytanchi E, Amini F, et al. Correlation of Blood Gas Parameters with Central Venous Pressure in Patients with Septic Shock; a Pilot Study. Bulletin of emergency & trauma. 2014;2(2):77.

Hosseini M, Baikpour M, Yousefifard M, Fayaz M, Koohpayehzadeh J, Ghelichkhani P, et al. Blood pressure percentiles by age and body mass index for adults. EXCLI journal. 2015;14:465-77.

Lundberg JS, Perl TM, Wiblin T, Costigan MD, Dawson J, Nettleman MD, et al. Septic shock: an analysis of outcomes for patients with onset on hospital wards versus intensive care units. Crit Care Med. 1998;26(6):1020-4.

Gattinoni L, Brazzi L, Pelosi P, Latini R, Tognoni G, Pesenti A, et al. A trial of goal-oriented hemodynamic therapy in critically ill patients. N Engl J Med. 1995;333(16):1025-32.

Elliott DC. An evaluation of the end points of resuscitation. J Am Coll Surg. 1998;187(5):536-47.

Yazigi A, El Khoury C, Jebara S, Haddad F, Hayeck G, Sleilaty G. Comparison of central venous to mixed venous oxygen saturation in patients with low cardiac index and filling pressures after coronary artery surgery. J Cardiothorac Vasc Anesth. 2008;22(1):77-83.

Marik PE, Baram M, Vahid B. Does central venous pressure predict fluid responsiveness?: a systematic review of the literature and the tale of seven mares. Chest J. 2008;134(1):172-8.

Marik PE, Cavallazzi R. Does the Central Venous Pressure Predict Fluid Responsiveness? An Updated Meta-Analysis and a Plea for Some Common Sense*. Crit Care Med. 2013;41(7):1774-81.

Eskesen TG, Wetterslev M, Perner A. Systematic review including re-analyses of 1148 individual data sets of central venous pressure as a predictor of fluid responsiveness. Intensive Care Med. 2016;42(3):324-32.

Boyd JH, Forbes J, Nakada T-a, Walley KR, Russell JA. Fluid resuscitation in septic shock: a positive fluid balance and elevated central venous pressure are associated with increased mortality. Crit Care Med. 2011;39(2):259-65.

Monnet X, Osman D, Ridel C, Lamia B, Richard C, Teboul J-L. Predicting volume responsiveness by using the end-expiratory occlusion in mechanically ventilated intensive care unit patients. Crit Care Med. 2009;37(3):951.

Bilello JF, Davis JW, Lemaster D, Townsend RN, Parks SN, Sue LP, et al. Prehospital hypotension in blunt trauma: identifying the “crump factor”. Journal of Trauma and Acute Care Surgery. 2011;70(5):1038-42.

Sevransky JE, Nour S, Susla GM, Needham DM, Hollenberg S, Pronovost P. Hemodynamic goals in randomized clinical trials in patients with sepsis: a systematic review of the literature. Critical Care. 2007;11(3):1.

Peake SL, Moran JL, Leppard PI. N-acetyl-L-cysteine depresses cardiac performance in patients with septic shock. Crit Care Med. 1996;24(8):1302-10.

Bollaert P-E, Charpentier C, Levy B, Debouverie M, Audibert G, Larcan A. Reversal of late septic shock with supraphysiologic doses of hydrocortisone. Crit Care Med. 1998;26(4):645-50.


Refbacks

  • There are currently no refbacks.


Copyright (c) 2016 Journal of Medical Physiology