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1.Basic Information
1.1.Basic Information

name

李永松

sex

male

age

84

hospital number

902149

height

cm

weight

kg

BSA

1.96 m2

APACHEⅡ

19

Infection source

lung

date

2017/11/25 年/月/日

Sequential Organ Failure Assessment

18

Fluid resuscitation

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.

yes

美罗培南针 1.0g ivgtt q8h

vasoactive agent

norepinephrine

120 min

150 min

300 min

2.vital signs

Temperature

36.3

Heart Rate

85 次/分

Breath

18 次/分

Systolic pressure (SP)

110 mmHg

Diastolic pressure

56 mmHg

mean arterial pressure

75 mmHg

3.Blood Gas Analysis

Pcv-aCO2

7.3 mmHg

DO2

581.1

VO2

143.3

Ca-vO2

45.1

2.3.、arterial blood gas analysis

pH value

7.45

PaO2

63.5 mmHg

PaCO2

30 mmHg

BE

-2.1 mmol/L(±2.3mmol/L)

SaO2

93.3 %

Blood lactic acid concentration, LAC

3.6 mmol/L

Oxygenation index (PaO2/FiO2)

79.4 mmHg

2.3.、Central venous blood gas analysis

pH value

7.41

PcvO2

39.9 mmHg

PcvCO2

37.3 mmHg

BE

-0.9 mmol/L

ScvO2

70.3 %

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

0.25 μg/Kg/min

dopamine

Dopamine Dosage

μg/Kg/min

Dobutamine

Dobutamine Dosage

μg/Kg/min

Milrinone

5.PiCCO parameters

CVP

7 mmHg

cardiac output

3.18 L/min

cardiac index

1.62 L/min/m2

stroke volume

43 ml

Stroke Index

19.1 ml/m2

ITBVI

824 ml/m2

GEDVI

659 ml/m2

EVLWI

19.5 ml/kg

PVPI

1.1

SVRI

3351 DSm2/cm5

CFI

3

GEF

12 %

SVV

7 %

PPV

%

dPmax

893

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

12

LUS

16

B+ Zone

8.inferior vena cava
2.8.1.、

IVC(inspiratory phase)

19 mm

IVC(expiratory phase)

18 mm

respiratory variations of inferior vena cavae diameter

5 %

2.8.2.、

15 mm

13 mm

12 mm

10 mm

3.T6
7..Inferior Vena Cava
3.7..1、

IVC(inspiratory phase)

21 mm

IVC(expiratory phase)

18 mm

Respiratory variations of inferior vena cavae diameter

14 %

3.7..2、

18 mm

15 mm

16 mm

12 mm

1..Vital Signs

Temperature

16.4

Heart Rate

76 次/分

Breath

19 次/分

Systolic Pressure

130 mmHg

Diastolic Pressure

66 mmHg

Mean Arterial Pressure

89 mmHg

2..Blood Gas Analysis

Pcv-aCO2

7.3 mmHg

DO2

591.4

VO2

132.1

Ca-vO2

40.3

3.2..、Arterial Blood Gases

PH value

7.44

PaO2

62.7 mmHg

PaCO2

31.3 mmHg

BE

-1.3 mmol/L

SaO2

92.7 %

Blood Lactic Acid Concentration

3.5 mmol/L

Oxygenation index (PaO2/FiO2)

78.4 mmHg

3.2..、Venous Blood Gas

PH value

7.41

PcvO2

40.8 mmHg

PcvCO2

38.6 mmHg

BE

-0.2 mmol/L

ScvO2

72 %

3..Vasoactive Agent and Fluid

Volume of input

1050 ml

Volume of output

200 ml

Volume of urine

200 ml

Ultrafiltration Volume

0 ml

Norepinephrine Dosage

5 mg

Dopamine Dosage

mg

Epinephrine Dosage

mg

Pituitrin Dosage

U

Dobutamine Dosage

mg

Milrinone Dosage

5 mg

Levosimendan

no

4..PiCCO Parameters

CVP

7 mmHg

cardiac output

3.28 L/min

cardiac index

1.67 L/min/m2

stroke volume

31 ml

Stroke Index

22 ml/m2

ITBVI

948 ml/m2

GEDVI

759 ml/m2

EVLWI

10.5 ml/kg

PVPI

2.2

SVRI

3918 DSm2/cm5

CFI

2

GEF

12 %

SVV

5 %

PPV

%

dPmax

821

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

10

LUS

12

B+ Zone

4.T12
1..Vital Signs

Temperature

36.4

Heart Rate

82 次/分

Breath

19 次/分

Systolic Pressure

147 mmHg

Diastolic Pressure

70 mmHg

Mean Arterial Pressure

98 mmHg

2..Blood Gas Analysis

Pcv-aCO2

7.9 mmHg

DO2

777.1

VO2

202.9

Ca-vO2

48.7

4.2..、Arterial Blood Gas

PH value

7.43

PaO2

89.7 mmHg

PaCO2

39.6 mmHg

BE

1.9 mmol/L

SaO2

97.8 %

Blood Lactic Acid Concentration

2.0 mmol/L

Oxygenation index (PaO2/FiO2)

149.5 mmHg

4.2..、Venous Blood Gas

PH value

7.39

PcvO2

40.1 mmHg

PcvCO2

47.5 mmHg

BE

2.7 mmol/L

ScvO2

72.3 %

3..Vasoactive Agent and Fluid

Volume of input

2100 ml

Volume of output

560 ml

Volume of urine

500 ml

Ultrafiltration Volume

0 ml

Norepinephrine Dosage

12 mg

Dopamine Dosage

mg

Epinephrine Dosage

mg

Pituitrin Dosage

U

Dobutamine Dosage

mg

Milrinone Dosage

10 mg

Levosimendan

no

4..PiCCO Parameters

CVP

4 mmHg

cardiac output

4.17 L/min

cardiac index

2.13 L/min/m2

stroke volume

42 ml

Stroke Index

25.9 ml/m2

ITBVI

854 ml/m2

GEDVI

684 ml/m2

EVLWI

10.5 ml/kg

PVPI

2.5

SVRI

3533 DSm2/cm5

CFI

3

GEF

15 %

SVV

5 %

PPV

%

dPmax

996

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

8

LUS

10

B+ Zone

7..Inferior Vena Cava
4.7..1、

IVC(inspiratory phase)

17 mm

IVC(expiratory phase)

12 mm

Respiratory variations of inferior vena cavae diameter

29 %

4.7..2、

15 mm

13 mm

13 mm

11 mm

5.T24
1.Vital Signs

Temperature

37.1

Heart Rate

72 次/分

Breath

18 次/分

Systolic Pressure

160 mmHg

Diastolic Pressure

77 mmHg

Mean Arterial Pressure

110 mmHg

2.Blood Gas Analysis

Pcv-aCO2

6.8 mmHg

DO2

716.0

VO2

403.5

Ca-vO2

100.1

5.2.、Arterial Blood Gas

PH value

7.49

PaO2

67.5 mmHg

PaCO2

35.4 mmHg

BE

3.9 mmol/L

SaO2

94.6 %

Blood Lactic Acid Concentration

1.2 mmol/L

Oxygenation index (PaO2/FiO2)

112.5 mmHg

5.2.、Venous Blood Gas

PH value

7.48

PcvO2

24.7 mmHg

PcvCO2

42.2 mmHg

BE

7.3 mmol/L

ScvO2

41.3 %

3.Vasoactive Agent and Fluid

Volume of input

2860 ml

Volume of output

1020 ml

Volume of urine

960 ml

Ultrafiltration Volume

0 ml

Norepinephrine Dosage

25 mg

Dopamine Dosage

mg

Epinephrine Dosage

mg

Pituitrin Dosage

U

Dobutamine Dosage

mg

Milrinone Dosage

30 mg

Levosimendan

no

4.PiCCO Parameters

CVP

9 mmHg

cardiac output

4.03 L/min

cardiac index

2.36 L/min/m2

stroke volume

48 ml

Stroke Index

22.8 ml/m2

ITBVI

1091 ml/m2

GEDVI

823 ml/m2

EVLWI

10.4 ml/kg

PVPI

1.9

SVRI

3419 DSm2/cm5

CFI

3

GEF

15 %

SVV

18 %

PPV

%

dPmax

753

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

5

LUS

8

B+ Zone

7.Inferior Vena Cava
5.7.1、

IVC(inspiratory phase)

18 mm

IVC(expiratory phase)

16 mm

Respiratory variations of inferior vena cavae diameter

11 %

5.7.2、

15 mm

13 mm

12 mm

10 mm

6.T48
1.Vital Signs

Temperature

37

Heart Rate

110 次/分

Breath

20 次/分

Systolic Pressure

125 mmHg

Diastolic Pressure

70 mmHg

Mean Arterial Pressure

91 mmHg

2.Blood Gas Analysis

Pcv-aCO2

10.5 mmHg

DO2

998.5

VO2

398.9

Ca-vO2

71.5

6.2.、Arterial Blood Gas

PH value

7.46

PaO2

68 mmHg

PaCO2

41.6 mmHg

BE

5.5 mmol/L

SaO2

94.6 %

Blood Lactic Acid Concentration

2.0 mmol/L

Oxygenation index (PaO2/FiO2)

170 mmHg

6.2.、Venous Blood Gas

PH value

7.45

PcvO2

41.2 mmHg

PcvCO2

52.1 mmHg

BE

4.5 mmol/L

ScvO2

56.8 %

3.Vasoactive Agent and Fluid

Volume of input

3700 ml

Volume of output

2180 ml

Volume of urine

2060 ml

Ultrafiltration Volume

0 ml

Norepinephrine Dosage

48 mg

Dopamine Dosage

mg

Epinephrine Dosage

mg

Pituitrin Dosage

U

Dobutamine Dosage

mg

Milrinone Dosage

60 mg

Levosimendan

no

4.PiCCO Parameters

CVP

5 mmHg

cardiac output

5.58 L/min

cardiac index

2.85 L/min/m2

stroke volume

50 ml

Stroke Index

25.9 ml/m2

ITBVI

1151 ml/m2

GEDVI

921 ml/m2

EVLWI

10.9 ml/kg

PVPI

1.9

SVRI

2415 DSm2/cm5

CFI

3

GEF

11 %

SVV

24 %

PPV

%

dPmax

595

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

3

LUS

6

B+ Zone

7.Inferior Vena Cava
6.7.1、

IVC(inspiratory phase)

17 mm

IVC(expiratory phase)

15 mm

Respiratory variations of inferior vena cavae diameter

12 %

6.7.2、

16 mm

14 mm

15 mm

12 mm

7.T72
1.Vital Signs

Temperature

36.9

Heart Rate

62 次/分

Breath

19 次/分

Systolic Pressure

117 mmHg

Diastolic Pressure

59 mmHg

Mean Arterial Pressure

81 mmHg

2.Blood Gas Analysis

Pcv-aCO2

8.4 mmHg

DO2

671.5

VO2

147.0

Ca-vO2

37.4

7.2.、Arterial Blood Gas

PH value

7.47

PaO2

60.7 mmHg

PaCO2

42.3 mmHg

BE

6.7 mmol/L

SaO2

92.3 %

Blood Lactic Acid Concentration

2.2 mmol/L

Oxygenation index (PaO2/FiO2)

151.8 mmHg

7.2.、Venous Blood Gas

PH value

7.46

PcvO2

39.9 mmHg

PcvCO2

50.7 mmHg

BE

5.6 mmol/L

ScvO2

72.1 %

3.Vasoactive Agent and Fluid

Volume of input

4800 ml

Volume of output

3750 ml

Volume of urine

3500 ml

Ultrafiltration Volume

0 ml

Norepinephrine Dosage

52 mg

Dopamine Dosage

mg

Epinephrine Dosage

mg

Pituitrin Dosage

U

Dobutamine Dosage

mg

Milrinone Dosage

80 mg

Levosimendan

no

4.PiCCO Parameters

CVP

6 mmHg

cardiac output

3.93 L/min

cardiac index

2.01 L/min/m2

stroke volume

37 ml

Stroke Index

32.3 ml/m2

ITBVI

1042 ml/m2

GEDVI

834 ml/m2

EVLWI

7.4 ml/kg

PVPI

1.4

SVRI

2991 DSm2/cm5

CFI

2

GEF

14 %

SVV

8 %

PPV

%

dPmax

5.8

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

2

LUS

5

B+ Zone

7.Inferior Vena Cava
7.7.1、

IVC(expiratory phase)

16 mm

Respiratory variations of inferior vena cavae diameter

15 %

IVC(inspiratory phase)

6 mm

7.7.2、

15 mm

13 mm

13 mm

10 mm

8.Day 1
1.Cardiac Function Indices

NT-proBNP

1113 pg/ml

BNP

pg/ml

cTNI

0.602 ng/ml

Creatine kinase isoenzyme, CKMB

59 U/L

2.Renel Function Indices

Creatinine

93 umol/L

Urea nitrogen

5.7 mmol/l

MDRD

ml/min/1.73m2

Date of examination

yyyy-mm-dd

3.Blood Routine Tests

WBC

20.1 X10*9/L

neutrophilic granulocyte percentage

92.3 %

Hb

146 g/L

CRP

24.31 mg/L

Procalcitonin, PCT

ng/ml

Date of test

4.Sequential Organ Failure Assessment

Sequential Organ Failure Assessment

18

9.Day 2
1.Cardiac Function Indices

NT-proBNP

pg/ml

BNP

2771 pg/ml

cTNI

0.203 ng/ml

Creatine kinase isoenzyme, CKMB

8 U/L

2.Renel Function Indices

Creatinine

87 umol/L

Urea nitrogen

13.3 mmol/l

MDRD

ml/min/1.73m2

3.Blood Routine Tests

WBC

20.7 X10*9/L

neutrophilic granulocyte percentage

94.7 %

Hb

140 g/L

CRP

303.67 mg/L

Procalcitonin, PCT

ng/ml

4.Sequential Organ Failure Assessment

Sequential Organ Failure Assessment

15

10.Day 3
1.Cardiac Function Indices

NT-proBNP

602 pg/ml

BNP

pg/ml

cTNI

0.01 ng/ml

Creatine kinase isoenzyme, CKMB

9 U/L

2.Renel Function Indices

Creatinine

69 umol/L

Urea nitrogen

14.1 mmol/L

MDRD

ml/min/1.73m2

3.Blood Routine Tests

WBC

13.9 X10*9/L

neutrophilic granulocyte percentage

92.7 %

Hb

141 g/L

CRP

250.5 mg/L

Procalcitonin, PCT

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

10

Complication

no

4.2.prognosis

prognosis

improve

28-day mortality

no

survival time(day)

death time

yyyy/mm/dd

diagnosis of death

length of stay

29

duration in ICU

10

duration of mechanical ventilation

192 小时

ICU expenses

65020

Continuous Renal Replacement Therapy

no

Continuous Renal Replacement Therapy

小时