title: [Clinical evaluation of transthoracic echocardiography predicting fluid responsiveness in septic shock].
abstract: OBJECTIVE
  To evaluate clinical value of transthoracic echocardiography (TTE) predicting fluid responsiveness in patients with severe sepsis or septic shock, the parameters of pulse indicator continuous cardiac output (PiCCO) system was combined.
  
  
  METHODS
  Twenty-eight severe sepsis or septic shock patients with mechanically ventilated in intensive care unit (ICU) of Wannan Medical College Yijishan Hospital were prospectively observed from March 2011 to December 2012. The hemodynamic parameters including stoke volume (SV), cardiac output (CO), cardiac output index (CI) and the distensibility index of the inferior vena cava (dIVC), descending aortic blood flow (ABF) were measured by PiCCO and/or TTE in the supine position. Responders were defined by the appearance of an increase in SV (ΔSV)≥10% after liquid loading. The value of TTE predicting fluid responsiveness was evaluated in severe sepsis or septic shock patients.
  
  
  RESULTS
  There were a total of 53 times liquid loading test in 28 patients, of which with 30 times was positive. The area under receiver operating characteristic curve (ROC curve, AUC) for dIVC predicting fluid responsiveness was 0.887, the dIVC threshold value of 22.5% had the sensitivity of 83.3% and specificity of 82.6% for prediction of fluid responsiveness. The AUC for ABF predicting fluid responsiveness was 0.794, the ABF variation threshold value of 10.95% had the sensitivity of 86.7% and specificity of 73.9% for prediction of fluid responsiveness. The AUC for SVTTE predicting fluid responsiveness was 0.919, the ΔSV of 12.9% had the sensitivity of 96.7% and specificity of 87.0% for prediction of fluid responsiveness. The SV, CO, CI of TTE were highly correlated with the SV, CO, CI of PiCCO before and after liquid loading (before liquid loading, r=0.901, 0.940, 0.909, after liquid loading r=0.911, 0.951, 0.940, all P=0.000).
  
  
  CONCLUSIONS
  Fluid responsiveness can be predicted using TTE in severe sepsis or septic shock patients.
authors: Department of Intensive Care Unit, the First Affiliated Hospital of Wannan Medical College, Wuhu Yijishan Hospital, Wuhu 241000, Anhui, China. Corresponding author: Lu Weihua, Email: lwh683@126.com.
authors: Jingyi
authors: J
authors: Wu
authors: Xia
authors: X
authors: Zhang
authors: Zhen
authors: Z
authors: Wang
authors: Biaohu
authors: B
authors: Liu
authors: Xiaogan
authors: X
authors: Jiang
authors: Weihua
authors: W
authors: Lu
authors: Xiaoju
authors: X
authors: Jin
authors: Xiaoting
authors: X
authors: Wang
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002302:Cardiac Output; D004452:Echocardiography; D005260:Female; D005440:Fluid Therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012772:Shock, Septic / Q000000981:diagnostic imaging* / Q000628:therapy*