Aguilar AMF, López AVG, Cetina CMA, Barradas RL

Language: Spanish
References: 16
Page: 78-86
PDF size: 234.45 Kb.

ABSTRACT

Background: Mortality associated with septic shock is still elevated, appropriate resuscitation and intravascular volume optimization are the cornerstones in the treatment. Optimization requires invasive monitoring and static measurements; therefore, a non-invasive, fast and dynamic method to make all measures is needed. Thoracic fluid content (TFC) by thoracic bioimpedance is a monitoring system that fulfills the requirements: non-invasive, of easy placement and dynamic.
Methods: Sixty patients were enrolled in the study and divided into two groups of 30 subjects each; all of them were admitted with a septic shock diagnosis in the ICU. Group F was formed by patients in whom TFC was measured by thoracic bioimpedance in order to guide intravascular volume optimization; Group C patients were optimized following the «Surviving Sepsis Campaign Guidelines». We recorded mortality at ICU discharge and at 28 days, length of mechanical ventilation and ICU length of stay.
Results: Based on TFC, group F obtained a faster and higher mean blood pressure (MBP), increasing up to 42.5% at 6 hours, compared to Group C, where MBP rose only 19.5% at 6 hours (p: ‹ 0.05). Regarding lactate clearance, group F obtained a total clearance of 54.4% and 66.6% at six and 12 hours; in group C, clearance came up only to 25.3% and 35.8% at six and 12 hours (p: 0.001). A higher mortality at ICU discharge was observed in group C, with 33.4% versus 26.7% (p: 0.001) in group F, 28 day mortality was 36.5% and 27.8% (p: 0.003) in groups C and F, respectively.
Conclusion: Measurement of thoracic fluid content by thoracic bioimpedance is effective when optimizing intravascular volume in septic shock.

REFERENCES

1. Dellinger RP, Levy MM, Carlet JM, et al. Surviving sepsis campaign: international guidelines for management of severe sepsis and septic shock: 2012. Crit Care Med. 2013;41(2):580-637

2. Daviaud F, Grimaldi D, Dechartes A, Charpentier J, Geri G, Marin N, et al. Timing and causes of death in septic shock. Ann Intensive Care. 2015;5(1):16.

3. Rivers E, Nguyen B, Havstad S, et al; Early Goal-Directed Therapy Collaborative Group. Early goal-directed therapy in the treatment of severe sepsis and septic shock. N Engl J Med. 2001;345:1368-1377.

4. Levy M. Early goal-directed therapy: what do we do now? Crit Care. 2014;18(6):705.

5. Cecconi M, Arulkumaran N, Kilic J, Ebm C, Rhodes A. Update on hemodynamic monitoring and management in septic patients. Minerva Anestesiol. 2014;80(6):701-711.

6. Georger J, Monnet X, Richard C, Teboul J. Impedance cardiography cardiac output: comparison with transpulmonary thermodilution. 20th ESICM Annual Congress; Berlin, Germany; 7-10 October, 2007.

7. Heinke M, Surber R, Kühnert H, Dannberg G, Sigusch H, Figulla O. Acceleration and thoracic fluid index with transthoracic impedance cardiography in heart failure patients with biventricular pacing. Biomed Techn. 2005;50(Suppl. 1):291-292.

8. Albert N. Bioimpedance cardiography measurement of cardiac output and other cardiovascular parameters. Crit Care Nurs Clin N Am. 2006;18:195-202.

9. Shoemaker W, Wo C, et al. Invasive and noninvasive hemodynamic monitoring of acutely ill sepsis and septic shock patients in the emergency department. Eur J Emerg Med. 2000;7:169-175.

10. Donati A, Botticelli L, Anastasi C, Romanelli M, Romagnoli L, Nardella R, et al. Variation of hemodynamic parameters after fluid challengue. Crit Care. 2008;12(Suppl. 2):P90.

11. Kang W, Lee J, Shin H, Kim S, Kim T, Seo D, et al. Noninvasive cardiac output monitoring in paediatric cardiac surgery: correlation between change in thoracic fluid content and change in patient body weight. J Int Med Res. 2012;40(6):295-304.

12. Charach G, Rubalsky O, Charach L, Rabinovich A, Argov O, Rogowski O, et al. Internal thoracic impedance —a useful method for expedient detection and convenient monitoring of pleural effusion. PLoS One. 2015;10(4):e0122576.

13. Abdelazeem E, Emad M, Ahmad A, Abdullah A, Abdulhamid S, Amal A, et al. Impedance cardiography: noninvasive assessment of hemodynamics and thoracic fluid content during bariatric surgery. Obes Surg. 2005;15(5):655-658.

14. Facchini C, Malfatto G, Giglio A, Facchini M, Parati G. Lung ultrasound and transthoracic impedance for noninvasive evaluation of pulmonary congestion in heart failure. J Cardiovasc Med (Hagerstown). 2015; [Epub ahead of print].

15. Boyd J, Forbes J, Nakada T, Walley K, Russell J. Fluid resuscitation in septic shock: a positive fluid balance and elevated central venous pressure are associated with increased mortality. Crit Care Med. 2011;39(2):259-265.

16. Ahmad F, Parvathaneni L, Silver M. Utility and economic benefit of thoracic bioimpedance in critical care patients. Journal of Cardiac Failure. 1999;5(3):81-81.