Point-of-care ultrasonography in assessing fluid responsiveness in sepsis patients: Sonographer characteristics, noninferential statistics, and study design: Answers to the september 2012 journal club questions

摘要

DISCUSSION POINTS: 1. Sepsis is a complex cascade of immunologic mechanisms related to systemic infection. There are many causes of sepsis, and many of its hemodynamic and metabolic derangements can occur concomitantly or independently. To counter toxin-mediated vasodilatation, early goal-directed therapy (EGDT) advocates aggressive fluid resuscitation. However, several criticisms have been made about the use of central venous pressure (CVP) in assessing fluid responsiveness and guiding EGDT. The Figure below highlights the major mechanisms in sepsis, and how fluid responsiveness is assessed with CVP and inferior vena cava (IVC) measurement. Areas of intersection (A, B, C) indicate the variance shared by these factors and the degree to which CVP or IVC measurement is able to predict fluid responsiveness.