Role of central venous pressure combined with passive leg raising in the assessment of volume responsiveness in patients with septic shock

ObjectiveTo investigate the role of central venous pressure(CVP) combined with passive leg raising(PLR) in the assessment of volume responsiveness in patients with septic shock.

MethodsOne hundred and ten patients with septic shock who were enrolled were selected as the research objects.The CVP, mean arterial pressure(MAP), stroke volume(SV), stroke volume variation(SVV), cardiac output(CO), cardiac index(CI) and heart rate(HR) were continuously monitored by pulse index continuous cardiac output(PiCCO), and PLR and volume load test were carried out.The change rates of CVP, SV, SVV and CI after PLR test were recorded as △CVP, △SV, △SVV, and △CI.The SV increment(△SV volume load test) ≥ 10% was regarded as positive group after volume load test, △SV volume load test < 10% was taken as negative group.Pearson test was used to analyze the correlation between △CVP and △SV, △SVV, △CI in patients with septic shock, and the ROC curve was used to analyze the predictive values of △CVP, △SV, △SVV, △CI on the volume responsiveness of patients with septic shock.

ResultsA total of 192 PLR and volume load test were carried out in 110 patients, including 88 cases in the positive group(45.83%) and 104 cases in the negative group(54.17%).After PLR test, CVP, SV and CI in the two groups were higher than the basic value, and those in the positive group were higher than the negative group; the SVV of the two groups was lower than the basic value, and that in the positive group was lower than the negative group, the difference was statistically significant(P < 0.05).△CVP of patients with septic shock was positively correlated with △SV and △CI(P < 0.05), negatively correlated with △SVV(P < 0.05).The area under the curve of the combination of △CVP, △SV, △SVV and △CI in predicting the volume response of patients with septic shock was 0.963, which was higher than that predicted by the four alone, the predictive sensitivity was 85.60%, and the specificity was 98.90%.

ConclusionsThe combination of △CVP, △SV, △SVV, △CI has the best prediction effect on the volume responsiveness of patients with septic shock.