title: Preload dependence indices to titrate volume expansion during septic shock: a randomized controlled trial.
abstract: BACKGROUND
  In septic shock, pulse pressure or cardiac output variation during passive leg raising are preload dependence indices reliable at predicting fluid responsiveness. Therefore, they may help to identify those patients who need intravascular volume expansion, while avoiding unnecessary fluid administration in the other patients. However, whether their use improves septic shock prognosis remains unknown. The aim of this study was to assess the clinical benefits of using preload dependence indices to titrate intravascular fluids during septic shock.
  
  
  METHODS
  In a single-center randomized controlled trial, 60 septic shock patients were allocated to preload dependence indices-guided (preload dependence group) or central venous pressure-guided (control group) intravascular volume expansion with 30 patients in each group. The primary end point was time to shock resolution, defined by vasopressor weaning.
  
  
  RESULTS
  There was no significant difference in time to shock resolution between groups (median (interquartile range) 2.0 (1.2 to 3.1) versus 2.3 (1.4 to 5.6) days in control and preload dependence groups, respectively). The daily amount of fluids administered for intravascular volume expansion was higher in the control than in the preload dependence group (917 (639 to 1,511) versus 383 (211 to 604) mL, P = 0.01), and the same held true for red cell transfusions (178 (82 to 304) versus 103 (0 to 183) mL, P = 0.04). Physiologic variable values did not change over time between groups, except for plasma lactate (time over group interaction, P <0.01). Mortality was not significantly different between groups (23% in the preload dependence group versus 47% in the control group, P = 0.10). Intravascular volume expansion was lower in the preload dependence group for patients with lower simplified acute physiology score II (SAPS II), and the opposite was found for patients in the upper two SAPS II quartiles. The amount of intravascular volume expansion did not change across the quartiles of severity in the control group, but steadily increased with severity in the preload dependence group.
  
  
  CONCLUSIONS
  In patients with septic shock, titrating intravascular volume expansion with preload dependence indices did not change time to shock resolution, but resulted in less daily fluids intake, including red blood cells, without worsening patient outcome.
  
  
  BACKGROUND
  Clinicaltrials.gov NCT01972828. Registered 11 October 2013.
authors.affiliation: Service de Réanimation Médicale, Hôpital De La Croix Rousse, Hospices Civils de Lyon, 103 Grande Rue de la Croix Rousse, 69004, Lyon, France. j-christophe.richard@chu-lyon.fr.|Université de Lyon, Université LYON I, 37 Rue du Repos, 69007, Lyon, France. j-christophe.richard@chu-lyon.fr.|CREATIS INSERM 1044 CNRS 5220, 20 Avenue Albert Einstein, 69621, Villeurbanne, France. j-christophe.richard@chu-lyon.fr.
authors.forename: Jean-Christophe
authors.initials: JC
authors.lastname: Richard
authors.affiliation: Service de Réanimation Médicale, Hôpital De La Croix Rousse, Hospices Civils de Lyon, 103 Grande Rue de la Croix Rousse, 69004, Lyon, France. frederique.bayle@chu-lyon.fr.
authors.forename: Frédérique
authors.initials: F
authors.lastname: Bayle
authors.affiliation: Service de Réanimation Médicale, Hôpital De La Croix Rousse, Hospices Civils de Lyon, 103 Grande Rue de la Croix Rousse, 69004, Lyon, France. gael.bourdin@chu-lyon.fr.
authors.forename: Gael
authors.initials: G
authors.lastname: Bourdin
authors.affiliation: Service de Réanimation Médicale, Hôpital De La Croix Rousse, Hospices Civils de Lyon, 103 Grande Rue de la Croix Rousse, 69004, Lyon, France. veronique.leray@chu-lyon.fr.
authors.forename: Véronique
authors.initials: V
authors.lastname: Leray
authors.affiliation: Service de Réanimation Médicale, Hôpital De La Croix Rousse, Hospices Civils de Lyon, 103 Grande Rue de la Croix Rousse, 69004, Lyon, France. sophie.debord@chu-lyon.fr.
authors.forename: Sophie
authors.initials: S
authors.lastname: Debord
authors.affiliation: Service de Réanimation Médicale, Hôpital De La Croix Rousse, Hospices Civils de Lyon, 103 Grande Rue de la Croix Rousse, 69004, Lyon, France. bertrand.delannoy@chu-lyon.fr.
authors.forename: Bertrand
authors.initials: B
authors.lastname: Delannoy
authors.affiliation: Service de Réanimation Médicale, Hôpital De La Croix Rousse, Hospices Civils de Lyon, 103 Grande Rue de la Croix Rousse, 69004, Lyon, France. alina.stoian-cividjian@chu-lyon.fr.|Université de Lyon, Université LYON I, 37 Rue du Repos, 69007, Lyon, France. alina.stoian-cividjian@chu-lyon.fr.
authors.forename: Alina Cividjian
authors.initials: AC
authors.lastname: Stoian
authors.affiliation: Service de Réanimation Médicale, Hôpital De La Croix Rousse, Hospices Civils de Lyon, 103 Grande Rue de la Croix Rousse, 69004, Lyon, France. florent.wallet@gmail.com.
authors.forename: Florent
authors.initials: F
authors.lastname: Wallet
authors.affiliation: Service de Réanimation Médicale, Hôpital De La Croix Rousse, Hospices Civils de Lyon, 103 Grande Rue de la Croix Rousse, 69004, Lyon, France. hodane.yonis@chu-lyon.fr.|Université de Lyon, Université LYON I, 37 Rue du Repos, 69007, Lyon, France. hodane.yonis@chu-lyon.fr.
authors.forename: Hodane
authors.initials: H
authors.lastname: Yonis
authors.affiliation: Service de Réanimation Médicale, Hôpital De La Croix Rousse, Hospices Civils de Lyon, 103 Grande Rue de la Croix Rousse, 69004, Lyon, France. claude.guerin@chu-lyon.fr.|Université de Lyon, Université LYON I, 37 Rue du Repos, 69007, Lyon, France. claude.guerin@chu-lyon.fr.|CREATIS INSERM 1044 CNRS 5220, 20 Avenue Albert Einstein, 69621, Villeurbanne, France. claude.guerin@chu-lyon.fr.
authors.forename: Claude
authors.initials: C
authors.lastname: Guerin
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002302:Cardiac Output; D002496:Central Venous Pressure; D005260:Female; D005440:Fluid Therapy / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012772:Shock, Septic / Q000503:physiopathology / Q000628:therapy*; D014662:Vasoconstrictor Agents / Q000627:therapeutic use
chemical_list: D014662:Vasoconstrictor Agents