Can the global end‐diastolic volume index guide fluid management in septic patients? A multicenter randomized controlled trial. Issue 1 (22nd November 2019)

• Record Type: Journal Article
• Authors: Morisawa, Kenichiro; Fujitani, Shigeki; Homma, Yosuke; Shigemitsu, Kazuaki; Saito, Nobuyuki; Hayakawa, Katsura; Yasuda, Hideto; Hifumi, Toru; Rinka, Hiroshi; Mayumi, Toshihiko; Fujiwara, Shinsuke; Murao, Yoshinori; Taira, Yasuhiko
• Is Part Of: Acute medicine & surgery. Volume 7:Issue 1(2020)
• Page Start: n/a
• Page End: n/a
• Publication Date: 2019-11-22
• Subjects: Early goal‐directed therapy -- global end‐diastolic volume index -- sepsis -- transpulmonary thermodilution -- volume resuscitation; Surgery -- Periodicals; Medical emergencies -- Periodicals; 617.005
• DOI: 10.1002/ams2.468
• Languages: English
• ISSNs: 2052-8817

Abstract

Abstract : Aim: An index that accurately measures intravascular volume is paramount for the optimal resuscitation of sepsis. Selecting an adequate indicator to substitute for central venous pressure (CVP) has remained an issue. The objective of our study was to compare the usefulness of standard early goal‐directed therapy (EGDT) with CVP (EGDT‐CVP) and modified EGDT with global end‐diastolic volume index (GEDI; EGDT‐GEDI) for sepsis. Methods: This was a multicenter prospective randomized controlled study. All patients with sepsis who were expected to require mechanical ventilator support for a minimum of 48 h were included. The patients were classified into an EGDT‐CVP group and an EGDT‐GEDI group. All participants underwent the extubation protocol. The primary outcome was the ventilator‐free days over a 28‐day period. Results: The ventilator‐free days was not significantly different between the two groups ( P = 0.59). However, the EGDT‐GEDI group showed a trend of shorter ventilator support duration (5.1 days [2.0–8.7 days] versus 3.9 days [2.4–5.7 days], P = 0.27) and length of stay in the intensive care unit (7.2 days [3.8–10.7 days] versus 5.1 days [3.7–8.8 days], P = 0.05) and a smaller 3‐day infusion balance than the EGDT‐CVP group (4, 405 mL [1, 092–8, 163 mL] versus 3, 046 mL [830–6, 806 mL], P = 0.34), but the differences were not statistically significant. Conclusion: Although there was no significant efficacy, EGDT guided by GEDI showed a trend of shorter length of stay in the intensive care unit and lower 3‐day infusion balance than the EGDT‐CVP group in sepsis. The GEDI monitoring did not appear to improve the ventilator‐free days over a 28‐day period. Abstract : We undertook a randomized controlled trial to assess the usefulness of the global end‐diastolic volume index (GEDI) as the mark of fluid resuscitation. GEDI did not appear to improve the ventilator‐free days over a 28‐day period or the length of stay in the intensive care unit to reduce excess fluid administration. The GEDI monitoring group showed a trend of a lower mean 72‐h infusion balance than the central venous pressure monitoring group.