[The therapeutic effects of fluid resuscitation in severe sepsis and septic shock]

Abstract

Objective: To evaluate the therapeutic effect of fluid resuscitation on severe sepsis and septic shock.

Methods: Twenty patients with severe sepsis and septic shock were given fluid resuscitation and got the following parameters in the ranges as follow: central venous pressure (CVP) 8 - 12 mm Hg (for ventilation patient: 12 - 15 mm Hg), mean artery pressure (MAP) 65 - 90 mm Hg, mixed venous oxygen saturation (SmvO(2)) > 70%. Hemodynamics, tissue perfusion and vascular endothelial cell function were measured and compared before and after fluid resuscitation.

Results: Pulmonary arterial wedge pressure (PAWP), cardiac index (CI), left ventricular stroke work index (LVSWI) and systemic vascular resistance index (SVRI) increased significantly after reached the goal of fluid resuscitation (P < 0.01) whereas pulmonary vascular resistance index (PVRI), lactate level in arterial blood and gastric-to-arterial carbon dioxide partial pressure gap (Pg-aCO(2)) decreased significantly (P < 0.01), and the serum levels of endothelin (ET) and von Willebrand factor (vWF) were also decreased significantly after fluid resuscitation (P < 0.05).

Conclusions: Early goal-directed fluid resuscitation can improve hemodynamics, tissue perfusion and alleviate vascular endothelial cell injury in patients with severe sepsis and septic shock, it is an effective therapy for these patients.