42645

A comparison of transesophageal Doppler corrected systolic flow time with central venous pressure to guide fluid resuscitation in septic shock : A prospective randomized trial

Thesis

Last updated: 06 Feb 2023

Subjects

-

Tags

Anaesthesiology

Advisors

Hamimi, Walid E. , Mukhtar, Ahmad M. , Fouad, Ahmad Z.

Authors

Sulayman, Mahmoud Salem

Accessioned

2017-07-12 06:41:22

Available

2017-07-12 06:41:22

type

M.D. Thesis

Abstract

Aortic corrected flow time (FTc) is easily measured by Doppler techniques. Recent data using transoesophageal Doppler suggest that it may predict fluid responsiveness in critical care. This use of FTc has not previously been evaluated in septic shock, only one preliminary study have incorporated transcutaneously measured FTc. Denoting its importance in prediction of fluid responsiveness in septic patient Furthermore, no comparison has been made between transesopahgeal FTc and central venous pressure. The aim of our study was to compare FTc, central venous pressure as predictors of fluid responsiveness in septic shock patients without cardiac dysrhythmia. This was a prospective study of 46 consecutive adult septic shock patients (in sinus rhythm; 44 out of 46 patients were mechanically ventilated) treated with intravenous fluid challenge (500 ml over 15 minutes) guided with CVP in control group and guided by FTC in Doppler group in a surgical tertiary intensive care unit. There were no statistically significant differences between the two groups at baseline, except for lower APACHE (P = 0.039) levels in the Doppler group than in the control group. Haemodynamic assessment incorporating transesophageal aortic Doppler (CardioQ®) measurements occurred shortly before and 1,6,12,hours after fluid challenge. Concurrent with initial assessment, blood samples were withdrawn and laboratory measurements documented1, 6,12, hours after fluid challenge and in 3 consecutive days. Five patients demonstrated an increase in stroke volume ≥10% (responders). Percent change in stroke volume strongly correlated with baseline FTc (r=-0.6831, P=0.000) but not central venous pressure (r=-0.0864, P=0.56). Baseline FTc <332 ms discriminated responders from non-responders [AUC = 0.989, 95% confidence interval = 0.954 to 1.023; P = 0.01)]. Our data support FTc as a better predictor of fluid responsiveness than central venous pressure in septic shock. Transesophagreal aortic Doppler FTc offers promise as a simple, completely non-invasive predictor of fluid responsiveness and should be evaluated further.

Issued

1 Jan 2014

DOI

http://dx.doi.org/10.21473/iknito-space/36582

Details

Type

Thesis

Created At

28 Jan 2023