الفهرس 
SHOCKOnly 14 pages are availabe for public view
 |  | from | 146 |  |  |
| | | from | 146 | | |
Abstract
S
epsis is a complex disorder that develops as a dysregulated host response to an infection, and is associated with acute organ dysfunction and a high risk of mortality. This syndrome needs urgent treatment, and thus awareness of the presenting characteristics is of great importance. The incidence of sepsis is high, and the condition remains one of the leading causes of death globally. Thus, sepsis is an important public health issue with considerable economic consequences.
Most of the described risk factors for the development of sepsis focus on a patient’s predisposition to infection. Very old or very young age, immunosuppressive diseases (e.g. AIDS), cancer, immunosuppressive medications, diabetes, alcohol abuse, indwelling catheters, or other conditions involving altered skin integrity all predispose patients to infection.
In sepsis, a host’s response to an infection manifests as signs of infection together with acute organ dysfunction. This dysfunction can lead to multiple organ failure, acidosis, and death.
The management of sepsis and septic shock should be undertaken as a medical emergency. Screening patients for signs and symptoms of sepsis and septic shock facilitates earlier identification and intervention. Effective treatment should focus on timely intervention, including removal of the source of infection and administration of vasopressors.
Norepinephrine is recommended as first-line vasopressor therapy with a target mean arterial pressure of 65 mmHg. High-dose vasopressor may also be required.
Predicting fluid responsiveness, Static cardiac filling pressures such as central venous pressure have shown to be incapable of predicting fluid responsiveness accurately.
Vasopressor weaning is less standardized than resuscitation and there are no RCTs of weaning. Patients are judged appropriate for gradual vasopressor dose decrements when reaching adequate volume status and perfusion. Deterioration necessitates titration back to higher doses, followed when “stability” recurs by repeated weaning.
Lower serum lactate level was significantly associated with earlier weaning from vasopressors in sever sepsis and septic shock.
Inferior vena cava collapsibility index assessment can be a sensitive and a good predictor of fluid responsiveness, being based on a safe and a non-invasive technique compared to other methods such as central venous pressure (CVP) measurement and pulmonary capillary wedge pressure measurement.
The aim of the current study was to elaborate the effectiveness of IVC collapsibility index versus serum lactate level as predictors for weaning from vasopressors in septic shock patients.
The results of the current study could be summarized as follows:
The criteria of the included patients showed that they had mean age 62.6 ± 6.32 years with male predominance (55.4%) and BMI equal to 30.5 ± 5.36. Most of patients had qSOFA score 2 and mean APACHE II score was 15.4 ± 4.3.
Serum lactate had the highest mean values at time of admission and decreased progressively since treatment initiation till the end of the 3rd day of admission with statistically significant differences regarding lactate at different time- points.
Inferior vena cava collapsibility index (IVCCI) was measured every 12 hours for all participants. IVCCI had the highest mean values at time of admission and decreased progressively since treatment initiation till the end of the 3rd day of admission with statistically significant differences regarding IVCCI at different time- points.
Dose of vasopressors were adjusted according to blood pressure then the required dose was recorded every 12 hours. Mean values of vasopressor doses decreased progressively with time. Some patients were weaned from vasopressors at the end of the 2nd day and some patients were weaned at the end of the 3rd day of admission.
There were no statistically significant correlations between vasopressor doses, serum lactate or IVCCI at different time- points.
To stratify the predictive value of serum lactate and IVCCI in weaning from vasopressors, patients were divided into 2 groups at the end of the 2nd day and at the end of the 3rd day: Weaned group and non- weaned group. Both groups were compared and performance of serum lactate and IVCCI in prediction of weaning from vasopressors at different time- points was assessed using Receiver Operator characteristics analysis.
At different measurements, IVCCI had larger area under curve with better diagnostic performance than serum lactate in prediction weaning from vasopressors.
CONCLUSION
S
erum lactate and inferior vena cava collapsibility index decrease significantly with improvement of sepsis and subsequent reduction of vasopressor doses. Changes in serum lactate and inferior vena cava collapsibility could predict changes in vasopressor doses with better performance for inferior vena cava collapsibility index.
RECOMMENDATIONS
W
e recommend using inferior vena cava collapsibility index to predict the weaning of vasopressors and subsequently the prognosis of septic shock.