A Pilot Study of PiCCO Monitoring in the Patients with Septic Shock

Objective: To evaluate the predictive value of global end-diastolic volume index(GEDVI) and central venous pressure(CVP) in patients with sepsis, and to assess GEDVI guided fluid management during 6 hours. Methods: Prospective clinical study.Eighteen cases of patients with sepsis were collected from the ICU department. They were facilitated endotracheal intubation and ventilation. A thermodilution femoral artery catheter was inserted into the femoral artery for Pi CCO monitor. A central venous catheter was inserted into subclavian vein. Each patient had seven hemodynamic measurements within 6 hours after facilitating Pi CCO monitor(T0~T6). Using Pi CCO decision tree for advanced hemodynamic management, Colloids and crystalloids were administered to maintain CI,GEDVI, and EVLWI as far as possible at nomal range. Results: The sensitivity, specificity, positive predictive value and negative predictive value of CVP with regard to volume depletion(GEDVI680 m L/m2), were 4%, 100%, 100% and 64%, and with regard to hypervolemia(GEDVI800) were 17%, 55%, 21% and 48%, respectively. CVP and ΔCVP did not correlate with CI and ΔCI. There was a significant correlation between GEDVI and extravascular lung water index(r=0.384, P0.001),but no correlation between CVP and extravascular lung water index(r=0.091, P=0.323). During the study, CVP decreased but CI and GEDVI increased. Conclusion: The predictive values of GEDVI with regard to volume depletion were sensible. The predictive values of CVP were not sensible. GEDVI was more appropriate for volume management in sepsis than CVP.