title: [An application of arterial pressure-based cardiac output measurements in fluid management strategies of critically ill patients].
abstract: OBJECTIVE
  To discuss the clinical significance of fluid management of severe patients according to arterial pressure-based cardiac output (APCO) monitoring volume responsiveness index.
  
  
  METHODS
  A retrospective cohort study was conducted. The severe patients were selected from the intensive care unit (ICU) of the First Hospital of Jilin University from June 1st, 2012 to December 31st, 2013. The hemodynamic parameters were monitored by APCO, and the fluid resuscitation was managed by stroke volume variation (SVV) and passive leg-raising test (PLR) when the acute physiology and chronic health evaluation II (APACHEII) score ≥ 15, heart rate >100 bpm with the result that the preload and heart function could not be evaluated. The heart rate, SVV, lactic acid (Lac) and central venous pressure (CVP) and curative effect were recorded before and after carrying out fluid management strategy. The criteria of clinical effective was defined as heart rate decreased and (or) stroke volume (SV) increased ≥ 10%, accompanied by blood Lac and SVV decreased, other than, the cases did not meet above criteria were considered ineffective.
  
  
  RESULTS
  Sixty-eight patients were enrolled in the study. (1) Before carrying out fluid management strategy: 40 cases with CVP>12 cmH₂O (1 cmH₂O=0.098 kPa), and 16 cases with 5-12 cmH₂O, 12 with <5 cmH₂O. SVV>13% in 35 cases, SVV <13% in 9 cases. PLR positive in 18 cases, and PLR negative in 6 cases. It was implicated that the patients with poor preload (SVV>13% and PLR positive) accounted by 77.9% (53/68). (2) There were 49 effective cases and 19 ineffective cases 4 hours after carrying out fluid management strategy, and the effective rate was 72.06% (49/68). While there were 56 effective cases and 12 ineffective cases after 12 hours, and the total effective rate was 82.35% (56/68). (3) In effective group, heart rate, SVV, Lac after fluid management strategy were significantly lower than those before fluid management strategy [4 hours after fluid management strategy: heart rate (bpm) 112.45 ± 13.53 vs. 129.55 ± 15.49, SVV (15.47 ± 6.32)% vs. (21.20 ± 7.40)%, Lac (mmol/L) 4.16 ± 3.12 vs. 6.21 ± 4.11; 12 hours after fluid management strategy: heart rate (bpm) 110.02 ± 13.92 vs. 129.61 ± 14.93, SVV (14.61 ± 15.52)% vs. (20.66 ± 7.40)%, Lac (mmol/L) 3.35 ± 2.26 vs. 6.11 ± 4.02, P<0.05 or P<0.01], while there was no significant difference in those markers between before and after fluid management strategy in ineffective group [4 hours after fluid management strategy: heart rate (bpm) 119.53 ± 11.68 vs. 125.79 ± 11.58, SVV (16.95 ± 6.48)% vs. (18.47 ± 4.96)%, Lac (mmol/L) 5.55 ± 3.80 vs. 6.54 ± 3.72; 12 hours after fluid management strategy: heart rate (bpm) 115.92 ± 11.71 vs. 123.40 ± 11.59, SVV (17.17 ± 6.09)% vs. (19.42 ± 8.25)%, Lac (mmol/L) 6.33 ± 3.40 vs. 7.21 ± 3.81, all P>0.05]. CVP only at 12 hours after fluid management strategy in effective group was significantly higher than that before fluid management strategy (cmH₂O: 12.8 8 ± 3.38 vs. 11.27 ± 4.97, P<0.05).
  
  
  CONCLUSIONS
  SVV monitored by APCO is a good indicator of volume responsiveness index, which can be used as an important reference combined with PLR for fluid management of severe patients.
authors.affiliation: Department of Intensive Care Unit, the First Hospital, Jilin University, Changchun 130021, Jilin, China, Corresponding author: Wang Yushan, Email: wang_yushan@163.com.
authors.forename: Dong
authors.initials: D
authors.lastname: Zhang
authors.forename: Yanfei
authors.initials: Y
authors.lastname: Song
authors.forename: Yimin
authors.initials: Y
authors.lastname: Yang
authors.forename: Aosong
authors.initials: A
authors.lastname: Duan
authors.forename: Zhibo
authors.initials: Z
authors.lastname: Zhang
authors.forename: Yushan
authors.initials: Y
authors.lastname: Wang
mesh_terms: D062186:Arterial Pressure; D002302:Cardiac Output; D002496:Central Venous Pressure; D015331:Cohort Studies; D016638:Critical Illness; D005440:Fluid Therapy; D006439:Hemodynamics; D006801:Humans; D007362:Intensive Care Units; D012189:Retrospective Studies; D013318:Stroke Volume