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1.Basic Information
1.1.Basic Information

name

王仲春

sex

male

age

57

hospital number

045200

height

170 cm

weight

60 kg

BSA

1.65 m2

APACHEⅡ

20

Infection source

lung

date

2017/4/14 年/月/日

Sequential Organ Failure Assessment

15

Fluid resuscitation

CVP8-12 mmHg
/
MAP≥65 mmHg
/
ScvO2≥70%
/
urine volume≥0.5

1.2.Inclusion Criteria

age>=60

yes

septic shock

yes

mechanical ventilation

trachea cannula

Early fluid resuscitation

yes

1.3.Exclusion Criteria

age<60

no

Pregnant woman

no

advanced malignant tumor

no

Pulmonary interstitial fibrosis

no

Serious arrhythmia

no

Small Tidal Volume Ventilation

no

Liver failure

no

Refuse to participate

no

1.4.Past medical history

Heart disease

no

no

no

no

no

no

2.T0
1.

no

米卡芬净100mgQD,斯沃0.6gQ12H

vasoactive agent

norepinephrine

30 min

30 min

30 min

2.vital signs

Temperature

38.6

Heart Rate

128 次/分

Breath

25 次/分

Systolic pressure (SP)

109 mmHg

Diastolic pressure

56 mmHg

mean arterial pressure

71 mmHg

3.Blood Gas Analysis

Pcv-aCO2

10 mmHg

DO2

349.9

VO2

116.6

Ca-vO2

33.8

2.3.、arterial blood gas analysis

pH value

7.25

PaO2

39 mmHg

PaCO2

63 mmHg

BE

-0.4 mmol/L(±2.3mmol/L)

SaO2

63 %

Blood lactic acid concentration, LAC

4.2 mmol/L

Oxygenation index (PaO2/FiO2)

39 mmHg

2.3.、Central venous blood gas analysis

pH value

7.23

PcvO2

29 mmHg

PcvCO2

73 mmHg

BE

1.6 mmol/L

ScvO2

42 %

4.vasoactive agent and fluid

Volume of input

0 ml

Volume of output

0 ml

Volume of urine

0 ml

ultrafiltration volume

0 ml

norepinephrine

yes

Norepinephrine Dosage

0.45 μg/Kg/min

dopamine

no

Dopamine Dosage

0 μg/Kg/min

Dobutamine

No

Dobutamine Dosage

0 μg/Kg/min

5.PiCCO parameters

CVP

11 mmHg

cardiac output

3.45 L/min

cardiac index

1.91 L/min/m2

stroke volume

27 ml

Stroke Index

14.9 ml/m2

ITBVI

831 ml/m2

GEDVI

665 ml/m2

EVLWI

13.6 ml/kg

PVPI

3.0

SVRI

2517 DSm2/cm5

CFI

3

GEF

9 %

SVV

24 %

PPV

%

dPmax

1155

6.Cardiac Ultrasound

LVEF

%

FS

%

SV

ml

CO

L/min

E peak

A peak

E/A

Ea(ventricular septum)

Ea(lateral wall)

E/Ea(ventricular septum)

E/Ea(lateral wall)

MAPSE

mm

TAPSE

mm

RV size

LVEDV

ml

LVEDD

cm

7.lung ultrasound

the number of B line

LUS

B+ Zone

8.inferior vena cava
2.8.1.、

IVC(inspiratory phase)

mm

IVC(expiratory phase)

mm

respiratory variations of inferior vena cavae diameter

%

2.8.2.、

mm

mm

mm

mm

3.T6
1..Vital Signs

Temperature

37.8

Heart Rate

135 次/分

Breath

27 次/分

Systolic Pressure

153 mmHg

Diastolic Pressure

64 mmHg

Mean Arterial Pressure

88 mmHg

2..Blood Gas Analysis

Pcv-aCO2

18 mmHg

DO2

384.4

VO2

201.3

Ca-vO2

53.1

3.2..、Arterial Blood Gases

PH value

7.14

PaO2

44 mmHg

PaCO2

63 mmHg

BE

-8.3 mmol/L

SaO2

63 %

Blood Lactic Acid Concentration

4.7 mmol/L

Oxygenation index (PaO2/FiO2)

44 mmHg

3.2..、Venous Blood Gas

PH value

7.09

PcvO2

28 mmHg

PcvCO2

81 mmHg

BE

-7.4 mmol/L

ScvO2

30 %

3..Vasoactive Agent and Fluid

Volume of input

2531 ml

Volume of output

100 ml

Volume of urine

50 ml

Ultrafiltration Volume

0 ml

Norepinephrine Dosage

6 mg

Dopamine Dosage

0 mg

Epinephrine Dosage

0 mg

Pituitrin Dosage

0 U

Dobutamine Dosage

0 mg

Milrinone Dosage

0 mg

Levosimendan

no

4..PiCCO Parameters

CVP

12 mmHg

cardiac output

3.79 L/min

cardiac index

2.09 L/min/m2

stroke volume

28.1 ml

Stroke Index

15.5 ml/m2

ITBVI

909 ml/m2

GEDVI

727 ml/m2

EVLWI

22.1 ml/kg

PVPI

4.8

SVRI

2902 DSm2/cm5

CFI

3

GEF

9 %

SVV

12 %

PPV

%

dPmax

2112

5..Cardiac Ultrasound

LVEF

%

FS

%

SV

ml

CO

L/min

E peak

A peak

E/A

Ea(ventricular septum)

Ea(lateral wall)

E/Ea(ventricular septum)

E/Ea(lateral wall)

MAPSE

mm

TAPSE

mm

RV size

LVEDV

ml

LVEDD

cm

6..Lung Ultrasound

The number of B line

LUS

B+ Zone

7..Inferior Vena Cava
3.7..1、

IVC(inspiratory phase)

mm

IVC(expiratory phase)

mm

Respiratory variations of inferior vena cavae diameter

%

3.7..2、

mm

mm

mm

mm

4.T12
1..Vital Signs

Temperature

36.8

Heart Rate

114 次/分

Breath

20 次/分

Systolic Pressure

154 mmHg

Diastolic Pressure

60 mmHg

Mean Arterial Pressure

95 mmHg

2..Blood Gas Analysis

Pcv-aCO2

9 mmHg

DO2

891.6

VO2

411.4

Ca-vO2

57.9

4.2..、Arterial Blood Gas

PH value

7.25

PaO2

50 mmHg

PaCO2

55 mmHg

BE

-3.8 mmol/L

SaO2

78 %

Blood Lactic Acid Concentration

2.6 mmol/L

Oxygenation index (PaO2/FiO2)

50 mmHg

4.2..、Venous Blood Gas

PH value

7.18

PcvO2

31 mmHg

PcvCO2

64 mmHg

BE

-5.4 mmol/L

ScvO2

42 %

3..Vasoactive Agent and Fluid

Volume of input

5035 ml

Volume of output

450 ml

Volume of urine

300 ml

Ultrafiltration Volume

0 ml

Norepinephrine Dosage

60 mg

Dopamine Dosage

0 mg

Epinephrine Dosage

0 mg

Pituitrin Dosage

0 U

Dobutamine Dosage

0 mg

Milrinone Dosage

0 mg

Levosimendan

no

4..PiCCO Parameters

CVP

20 mmHg

cardiac output

7.1 L/min

cardiac index

3.92 L/min/m2

stroke volume

62.3 ml

Stroke Index

34.4 ml/m2

ITBVI

1155 ml/m2

GEDVI

924 ml/m2

EVLWI

26.6 ml/kg

PVPI

4.4

SVRI

1529 DSm2/cm5

CFI

4

GEF

15 %

SVV

10 %

PPV

%

dPmax

2219

5..Cardiac Ultrasound

LVEF

%

FS

%

SV

ml

CO

L/min

E peak

A peak

E/A

Ea(ventricular septum)

Ea(lateral wall)

E/Ea(ventricular septum)

E/Ea(lateral wall)

MAPSE

mm

TAPSE

mm

RV size

LVEDV

ml

LVEDD

cm

6..Lung Ultrasound

The number of B line

LUS

B+ Zone

7..Inferior Vena Cava
4.7..1、

IVC(inspiratory phase)

mm

IVC(expiratory phase)

mm

Respiratory variations of inferior vena cavae diameter

%

4.7..2、

mm

mm

mm

mm

5.T24
1.Vital Signs

Temperature

38.5

Heart Rate

129 次/分

Breath

26 次/分

Systolic Pressure

98 mmHg

Diastolic Pressure

43 mmHg

Mean Arterial Pressure

56 mmHg

2.Blood Gas Analysis

Pcv-aCO2

17 mmHg

DO2

368.6

VO2

168.4

Ca-vO2

53.1

5.2.、Arterial Blood Gas

PH value

7.37

PaO2

47 mmHg

PaCO2

38 mmHg

BE

-3.0 mmol/L

SaO2

81 %

Blood Lactic Acid Concentration

2.7 mmol/L

Oxygenation index (PaO2/FiO2)

47 mmHg

5.2.、Venous Blood Gas

PH value

7.29

PcvO2

28 mmHg

PcvCO2

55 mmHg

BE

-0.8 mmol/L

ScvO2

44 %

3.Vasoactive Agent and Fluid

Volume of input

6575 ml

Volume of output

920 ml

Volume of urine

350 ml

Ultrafiltration Volume

420 ml

Norepinephrine Dosage

140 mg

Dopamine Dosage

0 mg

Epinephrine Dosage

0 mg

Pituitrin Dosage

0 U

Dobutamine Dosage

0 mg

Milrinone Dosage

0 mg

Levosimendan

no

4.PiCCO Parameters

CVP

11 mmHg

cardiac output

3.17 L/min

cardiac index

1.75 L/min/m2

stroke volume

24.6 ml

Stroke Index

13.6 ml/m2

ITBVI

736 ml/m2

GEDVI

589 ml/m2

EVLWI

29.3 ml/kg

PVPI

7.7

SVRI

2146 DSm2/cm5

CFI

3

GEF

10 %

SVV

21 %

PPV

%

dPmax

1573

5.Cardiac Ultrasound

LVEF

%

FS

%

SV

ml

CO

L/min

E peak

A peak

E/A

Ea(ventricular septum)

Ea(lateral wall)

E/Ea(ventricular septum)

E/Ea(lateral wall)

MAPSE

mm

TAPSE

mm

RV size

LVEDV

ml

LVEDD

cm

6.Lung Ultrasound

The number of B line

LUS

B+ Zone

7.Inferior Vena Cava
5.7.1、

IVC(inspiratory phase)

mm

IVC(expiratory phase)

mm

Respiratory variations of inferior vena cavae diameter

%

5.7.2、

mm

mm

mm

mm

6.T48
1.Vital Signs

Temperature

Heart Rate

次/分

Breath

次/分

Systolic Pressure

mmHg

Diastolic Pressure

mmHg

Mean Arterial Pressure

mmHg

2.Blood Gas Analysis

Pcv-aCO2

mmHg

DO2

VO2

Ca-vO2

6.2.、Arterial Blood Gas

PH value

PaO2

mmHg

PaCO2

mmHg

BE

mmol/L

SaO2

%

Blood Lactic Acid Concentration

mmol/L

Oxygenation index (PaO2/FiO2)

mmHg

6.2.、Venous Blood Gas

PH value

PcvO2

mmHg

PcvCO2

mmHg

BE

mmol/L

ScvO2

%

3.Vasoactive Agent and Fluid

Volume of input

ml

Volume of output

ml

Volume of urine

ml

Ultrafiltration Volume

ml

Norepinephrine Dosage

mg

Dopamine Dosage

mg

Epinephrine Dosage

mg

Pituitrin Dosage

U

Dobutamine Dosage

mg

Milrinone Dosage

mg

Levosimendan

4.PiCCO Parameters

CVP

mmHg

cardiac output

L/min

cardiac index

L/min/m2

stroke volume

ml

Stroke Index

ml/m2

ITBVI

ml/m2

GEDVI

ml/m2

EVLWI

ml/kg

PVPI

SVRI

DSm2/cm5

CFI

GEF

%

SVV

%

PPV

%

dPmax

5.Cardiac Ultrasound

LVEF

%

FS

%

SV

ml

CO

L/min

E peak

A peak

E/A

Ea(ventricular septum)

Ea(lateral wall)

E/Ea(ventricular septum)

E/Ea(lateral wall)

MAPSE

mm

TAPSE

mm

RV size

LVEDV

ml

LVEDD

cm

6.Lung Ultrasound

The number of B line

LUS

B+ Zone

7.Inferior Vena Cava
6.7.1、

IVC(inspiratory phase)

mm

IVC(expiratory phase)

mm

Respiratory variations of inferior vena cavae diameter

%

6.7.2、

mm

mm

mm

mm

7.T72
1.Vital Signs

Temperature

Heart Rate

次/分

Breath

次/分

Systolic Pressure

mmHg

Diastolic Pressure

mmHg

Mean Arterial Pressure

mmHg

2.Blood Gas Analysis

Pcv-aCO2

mmHg

DO2

VO2

Ca-vO2

7.2.、Arterial Blood Gas

PH value

PaO2

mmHg

PaCO2

mmHg

BE

mmol/L

SaO2

%

Blood Lactic Acid Concentration

mmol/L

Oxygenation index (PaO2/FiO2)

mmHg

7.2.、Venous Blood Gas

PH value

PcvO2

mmHg

PcvCO2

mmHg

BE

mmol/L

ScvO2

%

3.Vasoactive Agent and Fluid

Volume of input

ml

Volume of output

ml

Volume of urine

ml

Ultrafiltration Volume

ml

Norepinephrine Dosage

mg

Dopamine Dosage

mg

Epinephrine Dosage

mg

Pituitrin Dosage

U

Dobutamine Dosage

mg

Milrinone Dosage

mg

Levosimendan

4.PiCCO Parameters

CVP

mmHg

cardiac output

L/min

cardiac index

L/min/m2

stroke volume

ml

Stroke Index

ml/m2

ITBVI

ml/m2

GEDVI

ml/m2

EVLWI

ml/kg

PVPI

SVRI

DSm2/cm5

CFI

GEF

%

SVV

%

PPV

%

dPmax

5.Cardiac Ultrasound

LVEF

%

FS

%

SV

ml

CO

L/min

E peak

A peak

E/A

Ea(ventricular septum)

Ea(lateral wall)

E/Ea(ventricular septum)

E/Ea(lateral wall)

MAPSE

mm

TAPSE

mm

RV size

LVEDV

ml

LVEDD

cm

6.Lung Ultrasound

The number of B line

LUS

B+ Zone

7.Inferior Vena Cava
7.7.1、

IVC(expiratory phase)

mm

Respiratory variations of inferior vena cavae diameter

%

IVC(inspiratory phase)

mm

7.7.2、

mm

mm

mm

mm

8.Day 1
1.Cardiac Function Indices

NT-proBNP

pg/ml

BNP

1040 pg/ml

cTNI

0.257 ng/ml

Creatine kinase isoenzyme, CKMB

34.96 U/L

2.Renel Function Indices

Creatinine

99 umol/L

Urea nitrogen

5 mmol/l

MDRD

59.3 ml/min/1.73m2

Date of examination

2017/4/14 yyyy-mm-dd

3.Blood Routine Tests

WBC

2.4 X10*9/L

neutrophilic granulocyte percentage

91 %

Hb

120 g/L

CRP

169 mg/L

Procalcitonin, PCT

25.5 ng/ml

Date of test

2017/4/14

4.Sequential Organ Failure Assessment

Sequential Organ Failure Assessment

15

9.Day 2
1.Cardiac Function Indices

NT-proBNP

pg/ml

BNP

2170 pg/ml

cTNI

0.907 ng/ml

Creatine kinase isoenzyme, CKMB

29.9 U/L

2.Renel Function Indices

Creatinine

119.84 umol/L

Urea nitrogen

5.99 mmol/l

MDRD

50.4 ml/min/1.73m2

3.Blood Routine Tests

WBC

3.9 X10*9/L

neutrophilic granulocyte percentage

94.5 %

Hb

107 g/L

CRP

144.22 mg/L

Procalcitonin, PCT

ng/ml

4.Sequential Organ Failure Assessment

Sequential Organ Failure Assessment

17

10.Day 3
1.Cardiac Function Indices

NT-proBNP

pg/ml

BNP

pg/ml

cTNI

ng/ml

Creatine kinase isoenzyme, CKMB

U/L

2.Renel Function Indices

Creatinine

umol/L

Urea nitrogen

mmol/L

MDRD

ml/min/1.73m2

3.Blood Routine Tests

WBC

X10*9/L

neutrophilic granulocyte percentage

%

Hb

g/L

CRP

mg/L

Procalcitonin, PCT

ng/ml

4.Sequential Organ Failure Assessment

Sequential Organ Failure Assessment

11.At the end of the study
4.1.

Transfusion of Red Cells

yes

Transfusion of Red Cells

2 U

Plasma infusion

yes

Plasma infusion

200 ml

platelet transfusion

no

platelet transfusion

0 U

APACHEⅡ

20

Complication

no

4.2.prognosis

prognosis

die

28-day mortality

yes

survival time(day)

4

death time

2017/4/16 yyyy/mm/dd

diagnosis of death

多脏衰

length of stay

4

duration in ICU

4

duration of mechanical ventilation

70 小时

ICU expenses

26789

Continuous Renal Replacement Therapy

yes

Continuous Renal Replacement Therapy

10 小时