Central venous pressure and shock index predict lack of hemodynamic response to volume expansion in septic shock: a prospective, observational study.
OBJECTIVE
Volume expansion is a common therapeutic intervention in septic shock, although patient response to the intervention is difficult to predict. Central venous pressure (CVP) and shock index have been used independently to guide volume expansion, although their use is questionable. We hypothesize that a combination of these measurements will be useful.


METHODS
In a prospective, observational study, patients with early septic shock received 10-mL/kg volume expansion at their treating physician's discretion after brief initial resuscitation in the emergency department. Central venous pressure and shock index were measured before volume expansion interventions. Cardiac index was measured immediately before and after the volume expansion using transthoracic echocardiography. Hemodynamic response was defined as an increase in a cardiac index of 15% or greater.


RESULTS
Thirty-four volume expansions were observed in 25 patients. A CVP of 8 mm Hg or greater and a shock index of 1 beat min(-1) mm Hg(-1) or less individually had a good negative predictive value (83% and 88%, respectively). Of 34 volume expansions, the combination of both a high CVP and a low shock index was extremely unlikely to elicit hemodynamic response (negative predictive value, 93%; P = .02).


CONCLUSIONS
Volume expansion in patients with early septic shock with a CVP of 8 mm Hg or greater and a shock index of 1 beat min(-1) mm Hg(-1) or less is unlikely to lead to an increase in cardiac index.
Division of Pulmonary and Critical Care Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA. michael.lanspa@imail.org
Michael J
MJ
Lanspa
Samuel M
SM
Brown
Eliotte L
EL
Hirshberg
Jason P
JP
Jones
Colin K
CK
Grissom
D000368:Aged; D002496:Central Venous Pressure; D000077324:Crystalloid Solutions; D005260:Female; D006439:Hemodynamics; D006801:Humans; D007552:Isotonic Solutions / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D010952:Plasma Substitutes / Q000627:therapeutic use*; D011379:Prognosis; D011446:Prospective Studies; D012772:Shock, Septic / Q000175:diagnosis / Q000503:physiopathology* / Q000628:therapy*
D000077324:Crystalloid Solutions; D007552:Isotonic Solutions; D010952:Plasma Substitutes