Oord, M. (Martha) (2014) Spoedechografie in combinatie met non-invasieve cardiac output monitoring (NICOM®) als voorspellers van de volumerespons. thesis, Medicine.
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Abstract
Background: Sepsis is a frequently diagnosed disease in the emergency department with a high mortality rate up to 50%. The treatment of sepsis is generally based on fluid resuscitation, which only half of the treatment population responds to. In order to give the patient the right treatment, a fast and non-invasive method to predict fluid responsiveness would be of great interest. Objective: In this paper, we describe a trial investigating whether the respiratory variation in diameter of the vena cava inferior can be used as fluid responsiveness indicators. Furthermore, we investigate whether attributive sonography of the heart and lungs is a viable technique for fluid therapy guidance. Methods: During a trial period of 19 weeks all patients admitted to the emergency department were screened for sepsis and included if they were treated with at least 500 mL, 0,9% NaCl. Before fluid therapy, sonography (Zonare) was used to determine the caval index, to assess the contractility of the heart, and to screen the lungs for the presence of B-lines. The cardiac output and stroke volume was monitored before and after fluid therapy (NICOM Cheetah RELIANT). A positive response on fluid therapy was defined as an increase in stroke volume or cardiac output of at least 10%. Based on this definition, patients were divided into two groups; responders and non-responders. Results: A total of 37 patients with sepsis were included, of which 46% were responders. Results showed that the caval index was not reliable for predicting the response to fluid therapy. However, we observed a remarkable decrease in arterial pressure for all subjects. This behavior is most likely due to the increase in vasodilatation during the initial phase of sepsis, or loss of the initial stress response after being admitted to the emergency department. We hypothesise that the adequate treatment of sepsis includes treatment volumes of more than 1000mL, 0,9% NaCl. These treatment volumes were not associated with the development of additional complications. Conclusion: Based on the findings of this study, the caval index was found not to be viable as a fluid response predictor for patients with sepis. Furthermore, assessment of the global contractility of the left ventricle was not attributive for fluid therapy guidance.
| Item Type: | Thesis (Thesis) |
|---|---|
| Supervisor name: | Olgers, T.J. |
| Faculty: | Medical Sciences |
| Date Deposited: | 25 Jun 2020 10:58 |
| Last Modified: | 25 Jun 2020 10:58 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/1886 |
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