Effectiveness of volume therapy guided by response of CVP and global end-diastolic volume index in septic shock patients

Objective To evaluate the effectiveness of volume therapy guided by the response of CVP and global end-diastolic volume index (GEDVI) in septic shock patients.Methods Twenty-three patients of both sexes aged 18-64 yr who had been in septic shock for ＜ 6 h were randomly divided into 2 groups:control group (group Ⅰ,n =12) and study group (group Ⅱ,n =11 ).Tracheal intubation was performed and the patients were mechanically ventilated in both groups.Right internal jugular vein or subclavian vein was cannulated for CVP monitoring and fluid administration.PiCCO catheter was inserted into femoral artery.Normal saline,6％ hydroxyethyl starch 200/0.5,albumin and plasma were infused via CVP line.CVP was maintained ≥8 mm Hg in both groups while in Ⅱ group GEDVI was maintained at 600-750 ml/m2 during resuscitation.Blood samples were taken from artery and CVP line before (baseline) and at 6 h of volume therapy (T2) for determination of blood lactate concentration and central venous oxygen saturation ( ScVO2 ).The changing rate of lactate ( (baseline lactate concentration-lactate concentration at 6 h of volume therapy) ÷ baseline value × 100％ ) and ScvO2 ( ( ScvO2 at 6 h of volume therapy - baseline ScvO2 ) ÷ baseline value × 100％ ) ) was calculated.Results The changing rate of lactate was significantly higher in Ⅱ group than in Ⅰ group.There was no significant difference in the changing rate of ScvO2 between the 2 groups.Conclusion Volume therapy guided by CVP and GEDVI can provide better tissue perfusion than by CVP alone in septic shock patients. Key words: Cardiac output; Central venous pressure; Fluid therapy; Shock,septic