Non-Invasive Prediction of Fluid Responsiveness in Septic Shock: A Prospective Study of Transcutaneous Partial Pressure of Oxygen and Aortic Valve Velocity

Vollständiger Abstract

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Background and Aims Evaluating fluid responsiveness is essential in managing septic shock because both inadequate resuscitation and over-resuscitation can result in detrimental consequences. Non-invasive techniques are increasingly preferred to guide fluid therapy. This study aimed to evaluate the effectiveness of TCPO2 and AVVTI in predicting AVVTI-defined fluid responsiveness in patients with septic shock. Patients and Methods From September 2023 to March 2024, this prospective study was conducted in the intensive care unit of S L Raheja Hospital, Mumbai, India. A total of 69 adult septic shock patients with clinical indicators of tissue hypoperfusion and without contraindications to passive leg raising (PLR) were enrolled. TCPO2 was evaluated using a transcutaneous oxygen monitor, whereas AVVTI was determined by 2D echocardiography. For statistical analysis, Wilcoxon tests, Spearman's correlation, linear regression, and ROC curve analysis were used. Results Following PLR, TCPO2 and AVVTI exhibited significant increases from 73.9 ± 17.5 to 77.9 ± 18.5 units and from 13.5 ± 4.6 to 14.6 ± 4.8 units, respectively (both p = 0.001). A positive correlation was found between percentage change in TCPO2 and AVVTI (r = 0.53, p < 0.001). ROC analysis revealed that TCPO2 had an AUC of 0.81, with a sensitivity of 87.1% and specificity of 63.2% at a TCPO2 change cutoff of 4.9% for predicting AVVTI-defined fluid responsiveness. Age had a negative correlation with variation in TCPO2. Gender did not significantly influence baseline TCPO2 level. Conclusions TCPO2 and AVVTI are non-invasive tools that may assist in evaluating fluid responsiveness in septic shock. Variations in response of these measures according to patient age underscore the necessity for age-specific fluid management tools.