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1.Basic Information
1.1.Basic Information

name

阮孟德

sex

male

age

75

hospital number

512503

height

172 cm

weight

60 kg

BSA

1.71 m2

APACHEⅡ

36

Infection source

abdominal

date

2017/05/25 年/月/日

Sequential Organ Failure Assessment

12

Fluid resuscitation

1.2.Inclusion Criteria

age>=60

yes

septic shock

yes

mechanical ventilation

Early fluid resuscitation

no

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

yes

no

no

no

no

2.T0
1.

yes

泰能 0.5g q6h

vasoactive agent

norepinephrine

30 min

min

30 min

2.vital signs

Temperature

39.8

Heart Rate

163 次/分

Breath

32 次/分

Systolic pressure (SP)

112 mmHg

Diastolic pressure

67 mmHg

mean arterial pressure

85 mmHg

3.Blood Gas Analysis

Pcv-aCO2

6.3 mmHg

DO2

856.8

VO2

219.4

Ca-vO2

38.8

2.3.、arterial blood gas analysis

pH value

7.47

PaO2

118.5 mmHg

PaCO2

29.4 mmHg

BE

-4 mmol/L(±2.3mmol/L)

SaO2

98 %

Blood lactic acid concentration, LAC

4.4 mmol/L

Oxygenation index (PaO2/FiO2)

357.57 mmHg

2.3.、Central venous blood gas analysis

pH value

7.43

PcvO2

39.3 mmHg

PcvCO2

35.7 mmHg

BE

-3 mmol/L

ScvO2

73 %

4.vasoactive agent and fluid

Volume of input

2000 ml

Volume of output

300 ml

Volume of urine

300 ml

ultrafiltration volume

0 ml

norepinephrine

yes

Norepinephrine Dosage

0.28 μg/Kg/min

dopamine

no

Dopamine Dosage

μg/Kg/min

Dobutamine

No

Dobutamine Dosage

μg/Kg/min

Milrinone

5.PiCCO parameters

CVP

9 mmHg

cardiac output

5.66 L/min

cardiac index

3.31 L/min/m2

stroke volume

34.7 ml

Stroke Index

20.3 ml/m2

ITBVI

1198 ml/m2

GEDVI

959 ml/m2

EVLWI

10.8 ml/kg

PVPI

1.7

SVRI

1546 DSm2/cm5

CFI

3.2

GEF

8 %

SVV

%

PPV

%

dPmax

780

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

56

LUS

B+ Zone

8.inferior vena cava
2.8.1.、

IVC(inspiratory phase)

2.2 mm

IVC(expiratory phase)

2.2 mm

respiratory variations of inferior vena cavae diameter

0 %

2.8.2.、

2.3 mm

mm

2.3 mm

mm

3.T6
7..Inferior Vena Cava
3.7..1、

IVC(inspiratory phase)

2.3 mm

IVC(expiratory phase)

2.32 mm

Respiratory variations of inferior vena cavae diameter

1 %

3.7..2、

2.2 mm

mm

2.25 mm

mm

1..Vital Signs

Temperature

36.5

Heart Rate

95 次/分

Breath

26 次/分

Systolic Pressure

114 mmHg

Diastolic Pressure

82 mmHg

Mean Arterial Pressure

95 mmHg

2..Blood Gas Analysis

Pcv-aCO2

13.1 mmHg

DO2

753.7

VO2

179.6

Ca-vO2

36.7

3.2..、Arterial Blood Gases

PH value

7.38

PaO2

129.2 mmHg

PaCO2

29.7 mmHg

BE

-6 mmol/L

SaO2

98.7 %

Blood Lactic Acid Concentration

3.2 mmol/L

Oxygenation index (PaO2/FiO2)

390 mmHg

3.2..、Venous Blood Gas

PH value

7.31

PcvO2

36.8 mmHg

PcvCO2

42.8 mmHg

BE

-4.6 mmol/L

ScvO2

75.3 %

3..Vasoactive Agent and Fluid

Volume of input

2600 ml

Volume of output

500 ml

Volume of urine

900 ml

Ultrafiltration Volume

0 ml

Norepinephrine Dosage

6 mg

Dopamine Dosage

mg

Epinephrine Dosage

mg

Pituitrin Dosage

U

Dobutamine Dosage

mg

Milrinone Dosage

5 mg

Levosimendan

no

4..PiCCO Parameters

CVP

12 mmHg

cardiac output

4.9 L/min

cardiac index

2.87 L/min/m2

stroke volume

50.0 ml

Stroke Index

29.2 ml/m2

ITBVI

1314 ml/m2

GEDVI

1051 ml/m2

EVLWI

10.3 ml/kg

PVPI

1.4

SVRI

2679 DSm2/cm5

CFI

2.5

GEF

11 %

SVV

29 %

PPV

%

dPmax

283

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

56

LUS

B+ Zone

4.T12
1..Vital Signs

Temperature

36.6

Heart Rate

97 次/分

Breath

20 次/分

Systolic Pressure

127 mmHg

Diastolic Pressure

71 mmHg

Mean Arterial Pressure

94 mmHg

2..Blood Gas Analysis

Pcv-aCO2

5.3 mmHg

DO2

962.5

VO2

173.7

Ca-vO2

28.3

4.2..、Arterial Blood Gas

PH value

7.36

PaO2

112 mmHg

PaCO2

35.5 mmHg

BE

-5.2 mmol/L

SaO2

98.1 %

Blood Lactic Acid Concentration

2.4 mmol/L

Oxygenation index (PaO2/FiO2)

339.3 mmHg

4.2..、Venous Blood Gas

PH value

7.32

PcvO2

38.2 mmHg

PcvCO2

40.8 mmHg

BE

-4.6 mmol/L

ScvO2

80.5 %

3..Vasoactive Agent and Fluid

Volume of input

3080 ml

Volume of output

900 ml

Volume of urine

900 ml

Ultrafiltration Volume

0 ml

Norepinephrine Dosage

10 mg

Dopamine Dosage

mg

Epinephrine Dosage

mg

Pituitrin Dosage

U

Dobutamine Dosage

mg

Milrinone Dosage

10 mg

Levosimendan

no

4..PiCCO Parameters

CVP

10 mmHg

cardiac output

6.14 L/min

cardiac index

3.59 L/min/m2

stroke volume

63.3 ml

Stroke Index

37 ml/m2

ITBVI

1326 ml/m2

GEDVI

1061 ml/m2

EVLWI

9.0 ml/kg

PVPI

1.3

SVRI

1759 DSm2/cm5

CFI

3.2

GEF

13 %

SVV

%

PPV

%

dPmax

1018

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

40

LUS

B+ Zone

7..Inferior Vena Cava
4.7..1、

IVC(inspiratory phase)

2.2 mm

IVC(expiratory phase)

2.4 mm

Respiratory variations of inferior vena cavae diameter

8 %

4.7..2、

2.3 mm

mm

2.4 mm

mm

5.T24
1.Vital Signs

Temperature

36.8

Heart Rate

110 次/分

Breath

20 次/分

Systolic Pressure

131 mmHg

Diastolic Pressure

76 mmHg

Mean Arterial Pressure

97 mmHg

2.Blood Gas Analysis

Pcv-aCO2

3.8 mmHg

DO2

905.3

VO2

152.3

Ca-vO2

27.2

5.2.、Arterial Blood Gas

PH value

7.34

PaO2

92.4 mmHg

PaCO2

36.3 mmHg

BE

-5.3 mmol/L

SaO2

97.3 %

Blood Lactic Acid Concentration

2.2 mmol/L

Oxygenation index (PaO2/FiO2)

280 mmHg

5.2.、Venous Blood Gas

PH value

7.32

PcvO2

38.3 mmHg

PcvCO2

40.1 mmHg

BE

-4.7 mmol/L

ScvO2

81 %

3.Vasoactive Agent and Fluid

Volume of input

3486 ml

Volume of output

1495 ml

Volume of urine

1495 ml

Ultrafiltration Volume

0 ml

Norepinephrine Dosage

20 mg

Dopamine Dosage

mg

Epinephrine Dosage

mg

Pituitrin Dosage

U

Dobutamine Dosage

mg

Milrinone Dosage

20 mg

Levosimendan

no

4.PiCCO Parameters

CVP

13 mmHg

cardiac output

5.59 L/min

cardiac index

3.27 L/min/m2

stroke volume

45.1 ml

Stroke Index

26.4 ml/m2

ITBVI

1137 ml/m2

GEDVI

911 ml/m2

EVLWI

9.7 ml/kg

PVPI

1.6

SVRI

2299 DSm2/cm5

CFI

3.4

GEF

12 %

SVV

27 %

PPV

%

dPmax

905

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

42

LUS

B+ Zone

7.Inferior Vena Cava
5.7.1、

IVC(inspiratory phase)

1.9 mm

IVC(expiratory phase)

2.3 mm

Respiratory variations of inferior vena cavae diameter

19 %

5.7.2、

2.0 mm

mm

2.3 mm

mm

6.T48
1.Vital Signs

Temperature

37.7

Heart Rate

104 次/分

Breath

20 次/分

Systolic Pressure

117 mmHg

Diastolic Pressure

72 mmHg

Mean Arterial Pressure

90 mmHg

2.Blood Gas Analysis

Pcv-aCO2

0.8 mmHg

DO2

530.8

VO2

89.5

Ca-vO2

24.3

6.2.、Arterial Blood Gas

PH value

7.40

PaO2

123.7 mmHg

PaCO2

39.5 mmHg

BE

-0.3 mmol/L

SaO2

98.5 %

Blood Lactic Acid Concentration

1.8 mmol/L

Oxygenation index (PaO2/FiO2)

372 mmHg

6.2.、Venous Blood Gas

PH value

7.39

PcvO2

49.9 mmHg

PcvCO2

40.7 mmHg

BE

-0.4 mmol/L

ScvO2

82 %

3.Vasoactive Agent and Fluid

Volume of input

6715 ml

Volume of output

5300 ml

Volume of urine

5300 ml

Ultrafiltration Volume

0 ml

Norepinephrine Dosage

52 mg

Dopamine Dosage

mg

Epinephrine Dosage

mg

Pituitrin Dosage

U

Dobutamine Dosage

mg

Milrinone Dosage

40 mg

Levosimendan

no

4.PiCCO Parameters

CVP

8 mmHg

cardiac output

3.68 L/min

cardiac index

2.15 L/min/m2

stroke volume

35.4 ml

Stroke Index

20.7 ml/m2

ITBVI

860 ml/m2

GEDVI

688 ml/m2

EVLWI

7.2 ml/kg

PVPI

1.5

SVRI

3647 DSm2/cm5

CFI

2.9

GEF

12 %

SVV

%

PPV

%

dPmax

679

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

28

LUS

B+ Zone

7.Inferior Vena Cava
6.7.1、

IVC(inspiratory phase)

1.6 mm

IVC(expiratory phase)

2.0 mm

Respiratory variations of inferior vena cavae diameter

22 %

6.7.2、

1.7 mm

mm

2.1 mm

mm

7.T72
1.Vital Signs

Temperature

37.5

Heart Rate

103 次/分

Breath

25 次/分

Systolic Pressure

123 mmHg

Diastolic Pressure

76 mmHg

Mean Arterial Pressure

96 mmHg

2.Blood Gas Analysis

Pcv-aCO2

2 mmHg

DO2

801.6

VO2

145.3

Ca-vO2

24.7

7.2.、Arterial Blood Gas

PH value

7.42

PaO2

101.7 mmHg

PaCO2

40.3 mmHg

BE

0.4 mmol/L

SaO2

97.6 %

Blood Lactic Acid Concentration

1.9 mmol/L

Oxygenation index (PaO2/FiO2)

306 mmHg

7.2.、Venous Blood Gas

PH value

7.41

PcvO2

42.5 mmHg

PcvCO2

38.3 mmHg

BE

0.6 mmol/L

ScvO2

80 %

3.Vasoactive Agent and Fluid

Volume of input

10344 ml

Volume of output

8625 ml

Volume of urine

8625 ml

Ultrafiltration Volume

0 ml

Norepinephrine Dosage

72 mg

Dopamine Dosage

mg

Epinephrine Dosage

mg

Pituitrin Dosage

U

Dobutamine Dosage

mg

Milrinone Dosage

60 mg

Levosimendan

no

4.PiCCO Parameters

CVP

8 mmHg

cardiac output

5.88 L/min

cardiac index

3.44 L/min/m2

stroke volume

57.1 ml

Stroke Index

33.4 ml/m2

ITBVI

1153 ml/m2

GEDVI

923 ml/m2

EVLWI

7.2 ml/kg

PVPI

1.2

SVRI

2093 DSm2/cm5

CFI

3.5

GEF

14 %

SVV

22 %

PPV

%

dPmax

735

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

18

LUS

B+ Zone

7.Inferior Vena Cava
7.7.1、

IVC(expiratory phase)

1.8 mm

Respiratory variations of inferior vena cavae diameter

2.2 %

IVC(inspiratory phase)

20 mm

7.7.2、

1.6 mm

mm

2.1 mm

mm

8.Day 1
1.Cardiac Function Indices

NT-proBNP

pg/ml

BNP

675 pg/ml

cTNI

0.48 ng/ml

Creatine kinase isoenzyme, CKMB

5.6 U/L

2.Renel Function Indices

Creatinine

151 umol/L

Urea nitrogen

8.9 mmol/l

MDRD

ml/min/1.73m2

Date of examination

yyyy-mm-dd

3.Blood Routine Tests

WBC

23.7 X10*9/L

neutrophilic granulocyte percentage

95.3 %

Hb

115 g/L

CRP

177 mg/L

Procalcitonin, PCT

大于100 ng/ml

Date of test

4.Sequential Organ Failure Assessment

Sequential Organ Failure Assessment

12

9.Day 2
1.Cardiac Function Indices

NT-proBNP

pg/ml

BNP

196 pg/ml

cTNI

0.15 ng/ml

Creatine kinase isoenzyme, CKMB

6 U/L

2.Renel Function Indices

Creatinine

181 umol/L

Urea nitrogen

13.4 mmol/l

MDRD

ml/min/1.73m2

3.Blood Routine Tests

WBC

41.6 X10*9/L

neutrophilic granulocyte percentage

94.5 %

Hb

124 g/L

CRP

342 mg/L

Procalcitonin, PCT

大于100 ng/ml

4.Sequential Organ Failure Assessment

Sequential Organ Failure Assessment

12

10.Day 3
1.Cardiac Function Indices

NT-proBNP

pg/ml

BNP

105 pg/ml

cTNI

0.05 ng/ml

Creatine kinase isoenzyme, CKMB

4 U/L

2.Renel Function Indices

Creatinine

166 umol/L

Urea nitrogen

15.1 mmol/L

MDRD

ml/min/1.73m2

3.Blood Routine Tests

WBC

25.6 X10*9/L

neutrophilic granulocyte percentage

93.9 %

Hb

109 g/L

CRP

229 mg/L

Procalcitonin, PCT

39.4 ng/ml

4.Sequential Organ Failure Assessment

Sequential Organ Failure Assessment

10

11.At the end of the study
4.1.

Transfusion of Red Cells

no

Transfusion of Red Cells

U

Plasma infusion

no

Plasma infusion

ml

platelet transfusion

no

platelet transfusion

U

APACHEⅡ

20

Complication

4.2.prognosis

prognosis

department transference

28-day mortality

survival time(day)

death time

yyyy/mm/dd

diagnosis of death

length of stay

duration in ICU

6

duration of mechanical ventilation

0 小时

ICU expenses

4166

Continuous Renal Replacement Therapy

no

Continuous Renal Replacement Therapy

小时