Abstract Objective To explore the predictive value of low volume volume expansion（Low－ VE）and pulse contour－derived cardiac index（PiCCO）on fluid responsiveness in elderly patients with septic shock. Methods A prospective observational cohort study was conducted. Forty－six elderly pa⁃ tients sufferingfrom septic shock admitted to Department of Intensive Care Unit of our hospital from May 2014 to April 2015 were enrolled. The patients were studied in three phases: before test, Low－VE（100 mL saline infused with 1 minute）, and volume expansion（VE）with infusing of 250 mL saline within 10 minutes. Hemodynamic parameters were recorded in every phase. Responders and nonresponders were de⁃ fined by stroke volume（SV）variation after VE. A positive response was defined as a ≥15% increase in SV（ΔSVVE≥15%）. The receiver operating characteristic（ROC）curve was used to predict the value of hemodynamic parameters before and after Low－VE. Results Of 46 patients, 16 patients were responders, and 30 non－responders. The changes in SV and cardiac output（CO）after Low－VE（ΔSVLow－ VE andΔCOLow － VE）were significantly higher in responders than those of non－responders［ΔSVLow － VE:（11.0±3.5）% vs.（4.6±2.7）%, t＝6.882 , P＝0.000; ΔCOLow－ VE:（9.7±4.5）% vs.（4.1±3.2）%, t＝4.857, P＝0.000］, but there was no significant difference in the changes in systolic blood pressure（SBP）, meanarterial pressure（MAP）, pulse pressure（PP）, and heart rate（HR）after Low － VE（ΔSBPLow － VE,ΔMAPLow － VE, ΔPPLow － VE and ΔHRLow － VE）between two groups. The area under ROC curve（AUC）of
ΔSVLow － VE≥8.1% for predicting fluid responsiveness was（0.928±0.042, P＝0.000）, with sensitivity of81.2% and specificity of 93.3%; the AUC of ΔCOLow － VE≥6.3% for predicting fluid responsiveness was（0.858±0.057, P＝0.000）, with sensitivity of 87.5% and specificity of 73.3%. Conclusion In elderlypatients with septic shock, changes in SV and CO induced by Low－VE are accurate indices for pre⁃dicting fluid responsiveness, but the changes in SBP, MAP, PP, HR and stroke volume variation（SVV）cannot predict the fluid responsiveness.
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Received: 04 October 2016
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