METHODS: Thirty-four septic shock patients were included. Fluid responsiveness was assessed at baseline, and a FC (500 ml/30 mins) was administered in 9 fluid-responsive patients. A VPT was performed in 25 patients by increasing norepinephrine dose to reach a MAP to 80-85 mmHg for 30 min. Patients shared a multimodal perfusion and hemodynamic monitoring protocol with assessments at at least two time-points (baseline, and at the end of interventions).
RESULTS: CRT decreased significantly with both tests (from 5 [3.5-7.6] to 4 [2.4-5.1] sec, p = 0.008 after the FC; and from 4.0 [3.3-5.6] to 3 [2.6 -5] sec, p = 0.03 after the VPT. A CRT-response was observed in 7/9 patients after the FC, and in 14/25 pts after the VPT, but CRT deteriorated in 4 patients on this latter group, all of them receiving a concomitant low-dose vasopressin.
CONCLUSIONS: Our findings support that fluid boluses may improve CRT or produce neutral effects in fluid-responsive septic shock patients with persistent hypoperfusion. Conversely, raising NE doses to target a higher MAP in previously hypertensive patients elicits a more heterogeneous response, improving CRT in the majority, but deteriorating skin perfusion in some patients, a fact that deserves further research.
方法:纳入34例脓毒性休克患者。在基线时评估液体反应性,和FC(500毫升/30分钟)在9例流体反应的患者。通过增加去甲肾上腺素剂量使MAP达到80-85mmHg30分钟,对25例患者进行了VPT。患者在至少两个时间点(基线,并在干预结束时)。
结果:CRT在两次测试中都显着降低(从5[3.5-7.6]到4[2.4-5.1]秒,FC后p=0.008;从4.0[3.3-5.6]到3[2.6-5]秒,VPT后p=0.03。在FC后的7/9患者中观察到CRT反应,在VPT后的14/25分中,但在后一组中有4名患者CRT恶化,他们都同时接受低剂量加压素。
结论:我们的研究结果支持液体推注可以改善持续低灌注的液体反应性脓毒性休克患者的CRT或产生中性效应。相反,在以前的高血压患者中提高NE剂量以靶向更高的MAP引起更异质的反应,在大多数情况下改善CRT,但是一些患者的皮肤灌注恶化,一个值得进一步研究的事实。