Respiratory Variations in Peak Peripheral Artery Velocities and Waveforms for Rapid Assessment of Fluid Responsiveness in Traumatic Shock Patients.

BACKGROUND This study aimed to assess the correlation between the variability of the end-inspiratory and end-expiratory blood flow waveform and fluid responsiveness (FR) in traumatic shock patients who underwent mechanical ventilation by evaluating peripheral arterial blood flow parameters. MATERIAL AND METHODS A cohort of 60 patients with traumatic shock requiring mechanical ventilation-controlled breathing received ultrasound examinations to assess the velocity of carotid artery (CA), femoral artery (FA) and brachial artery (BA). A rehydration test was performed in which of 250 mL of 0.9% saline was administered within 30 min between the first and second measurement of cardiac output by echocardiography. Then, all patients were divided into 2 groups, a responsive group (FR+) and a non-responsive group (FR-). The velocity of end-inspiratory and end-expiratory peripheral arterial blood flow of all patients was ultrasonically measured, and the variability were measured between end-inspiratory and end-expiratory. RESULTS The changes in the end-inspiratory and end-expiratory carotid artery blood flow velocity waveforms of the FR+ groups were significantly different from those of the FR- group (P<0.001). A statistically significant difference in ΔVmax (CA), ΔVmax (BA), and ΔVmax (FA) between these 2 groups was found (all P<0.001). The ROC curve showed that DVmax (CA) and ΔVmax (BA) were more sensitive values to predict FR compared to ΔVmax (FA). The sensitivity of ΔVmax (CA), ΔVmax (FA), and ΔVmax (BA) was 70.0%, 86.7%, and 93.3%, respectively. CONCLUSIONS The study showed that periodic velocity waveform changes in the end-inspiratory and end-expiratory peripheral arterial blood flow can be used for quick assessment of fluid responsiveness.

[Combination of Weighted index of comorbidities and sepsis-related organ failure assessment score in death risk evaluation of septic patients].

OBJECTIVE: To predict the risk of 28- day mortality on septic patients in intensive care unit (ICU) with the combination of the Weighted index of comorbidities (WIC) and sepsis-related organ failure assessment (SOFA) score. METHODS: The clinical data of adult sever sepsis/ septic shock patients in Department of Emergency Medicine of Chagzeng Hospital and Department of Clinical Care Medicine of Jinan Military General Hospital from October 2011 to February 2013 were analyzed retrospectively. The etiological factor, past history, having sever sepsis or not were recorded. Age score, WIC score, acute physiology and chronic health evaluation II (APACHE II) score and SOFA score were calculated at or 24 hours after admission. The logistic regression was used and the receiver operating characteristic curve (ROC curve) was drawn to calculate the patients' outcome. RESULTS: In 310 enrolled patients, 223 (71.9%) patients survived and 87 (28.1%) died. Univariate analysis showed the P values of the age score, WIC score, APACHE II score and SOFA score. chronic cardiac insufficiency, type 2 diabetes, cerebrovascular disease, tumor, multiple injury, pulmonary infection and having severe sepsis or not were all less tha 0.2. The above 11 variables were put into the multivariate logistic regression equation 1, of which predicted probability was reserved. It revealed that 5 variables were independently associated with 28-day prognosis, of which influence power in descending order were SOFA score [odds ratio (OR)=1.308, 95 % confidence interval (95% CI): 1.158-1.478, P=0.000], having sever sepsis or not (OR=0.206, 95% Cl:0.100-0.424, P=0.000), APACHE II score (OR=1.090, 95% CI:1.021-1.164, P=0.010) WIC score (OR=1.441, 95% CI:1.067-1.947, P=0.017) age score (OR=1.228, 95% CI:1.027-1.468, P=0.024), the Wals were 18.554, 18.369, 6.725, 5.662, 5.067, respectively. The 3 variables, age score, WIC score and SOFA score, were brought into the multivariate logistic regression equation 2, of which predicted probability was reserved too. It revealed that age score (OR=1.330, 95 % CI: 1.145-1.546, P=0.000), WIC score (OR=1.496, 95% CI: 1.145-1.546, P=000) and SOFA score (OR=1.429, 95% CI: 1.303-1.567, P=0.000), were independently associated with the septic patients' 28-day prognosis. There was no significant difference in the area under receiver operating characteristics curve (AUC) between the SOFA score and APACHE II score (0.784 vs. 0.780, Z=0.014, P=0.989). However, compared with APACHE II score, the AUC of equation 1 (0.888) and 2 (0.851) were much more (Z=4.333, P= 0.000; Z= 2.669, P= 0.008). CONCLUSION: The sensitivity of 28-day prognosis 28-day prognosis by WIC score was improved greatly with the combination of SOFA score and age score.