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1.Basic Information
1.1.Basic Information

name

王小萍

sex

female

age

42

hospital number

900454

height

158 cm

weight

55 kg

BSA

1.64 m2

APACHEⅡ

20

Infection source

lung

date

2017/10/29 年/月/日

Sequential Organ Failure Assessment

16

Fluid resuscitation

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

1.2.Inclusion Criteria

age>=60

no

septic shock

yes

mechanical ventilation

trachea cannula

Early fluid resuscitation

yes

1.3.Exclusion Criteria

age<60

yes

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

泰能 1.0 ivgtt q8h

vasoactive agent

norepinephrine

100 min

60 min

30 min

2.vital signs

Temperature

37.2

Heart Rate

134 次/分

Breath

22 次/分

Systolic pressure (SP)

150 mmHg

Diastolic pressure

84 mmHg

mean arterial pressure

109 mmHg

3.Blood Gas Analysis

Pcv-aCO2

-4.7 mmHg

DO2

687.2

VO2

137.5

Ca-vO2

26.3

2.3.、arterial blood gas analysis

pH value

7.42

PaO2

56.4 mmHg

PaCO2

25.8 mmHg

BE

-7 mmol/L(±2.3mmol/L)

SaO2

87.6 %

Blood lactic acid concentration, LAC

1.6 mmol/L

Oxygenation index (PaO2/FiO2)

80.6 mmHg

2.3.、Central venous blood gas analysis

pH value

7.38

PcvO2

32.1 mmHg

PcvCO2

21.1 mmHg

BE

-8 mmol/L

ScvO2

70.1 %

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

2.2 μg/Kg/min

dopamine

no

Dopamine Dosage

0 μg/Kg/min

Dobutamine

No

Dobutamine Dosage

0 μg/Kg/min

5.PiCCO parameters

CVP

17 mmHg

cardiac output

5.22 L/min

cardiac index

5.18 L/min/m2

stroke volume

39 ml

Stroke Index

25.8 ml/m2

ITBVI

1461 ml/m2

GEDVI

1169 ml/m2

EVLWI

9.8 ml/kg

PVPI

2.5

SVRI

2311 DSm2/cm5

CFI

4

GEF

14 %

SVV

3 %

PPV

%

dPmax

1683

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

5

LUS

6

B+ Zone

8.inferior vena cava
2.8.1.、

IVC(inspiratory phase)

18 mm

IVC(expiratory phase)

16 mm

respiratory variations of inferior vena cavae diameter

11 %

2.8.2.、

13 mm

10 mm

10 mm

8 mm

3.T6
1..Vital Signs

Temperature

36.9

Heart Rate

100 次/分

Breath

18 次/分

Systolic Pressure

124 mmHg

Diastolic Pressure

85 mmHg

Mean Arterial Pressure

100 mmHg

2..Blood Gas Analysis

Pcv-aCO2

-8.6 mmHg

DO2

621.7

VO2

176.5

Ca-vO2

41.5

3.2..、Arterial Blood Gases

PH value

7.32

PaO2

122 mmHg

PaCO2

28.6 mmHg

BE

10.8 mmol/L

SaO2

99 %

Blood Lactic Acid Concentration

0.8 mmol/L

Oxygenation index (PaO2/FiO2)

174.3 mmHg

3.2..、Venous Blood Gas

PH value

7.31

PcvO2

35 mmHg

PcvCO2

20 mmHg

BE

-11.2 mmol/L

ScvO2

71 %

3..Vasoactive Agent and Fluid

Volume of input

3560 ml

Volume of output

2100 ml

Volume of urine

2050 ml

Ultrafiltration Volume

0 ml

Norepinephrine Dosage

15 mg

Dopamine Dosage

mg

Epinephrine Dosage

mg

Pituitrin Dosage

U

Dobutamine Dosage

mg

Milrinone Dosage

mg

Levosimendan

4..PiCCO Parameters

CVP

13 mmHg

cardiac output

4.25 L/min

cardiac index

2.59 L/min/m2

stroke volume

42.5 ml

Stroke Index

25.9 ml/m2

ITBVI

707 ml/m2

GEDVI

565 ml/m2

EVLWI

9.4 ml/kg

PVPI

2.4

SVRI

2684 DSm2/cm5

CFI

5

GEF

19 %

SVV

12 %

PPV

%

dPmax

1683

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

8

B+ Zone

7..Inferior Vena Cava
3.7..1、

IVC(inspiratory phase)

19 mm

IVC(expiratory phase)

17 mm

Respiratory variations of inferior vena cavae diameter

11 %

3.7..2、

15 mm

10 mm

13 mm

10 mm

4.T12
1..Vital Signs

Temperature

37

Heart Rate

96 次/分

Breath

16 次/分

Systolic Pressure

122 mmHg

Diastolic Pressure

74 mmHg

Mean Arterial Pressure

92 mmHg

2..Blood Gas Analysis

Pcv-aCO2

5.8 mmHg

DO2

952.5

VO2

224.8

Ca-vO2

35.8

4.2..、Arterial Blood Gas

PH value

7.31

PaO2

114 mmHg

PaCO2

33.3 mmHg

BE

-8.6 mmol/L

SaO2

98.2 %

Blood Lactic Acid Concentration

0.8 mmol/L

Oxygenation index (PaO2/FiO2)

285 mmHg

4.2..、Venous Blood Gas

PH value

7.33

PcvO2

46.5 mmHg

PcvCO2

39.1 mmHg

BE

-5 mmol/L

ScvO2

75.1 %

3..Vasoactive Agent and Fluid

Volume of input

4800 ml

Volume of output

2850 ml

Volume of urine

2700 ml

Ultrafiltration Volume

0 ml

Norepinephrine Dosage

25 mg

Dopamine Dosage

mg

Epinephrine Dosage

mg

Pituitrin Dosage

U

Dobutamine Dosage

mg

Milrinone Dosage

mg

Levosimendan

4..PiCCO Parameters

CVP

9 mmHg

cardiac output

6.28 L/min

cardiac index

3.83 L/min/m2

stroke volume

65.4 ml

Stroke Index

39.9 ml/m2

ITBVI

827 ml/m2

GEDVI

662 ml/m2

EVLWI

8.2 ml/kg

PVPI

1.8

SVRI

1253 DSm2/cm5

CFI

6

GEF

24 %

SVV

3 %

PPV

%

dPmax

596

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

6

LUS

5

B+ Zone

7..Inferior Vena Cava
4.7..1、

IVC(inspiratory phase)

18 mm

IVC(expiratory phase)

15 mm

Respiratory variations of inferior vena cavae diameter

17 %

4.7..2、

16 mm

12 mm

15 mm

10 mm

5.T24
1.Vital Signs

Temperature

36.7

Heart Rate

94 次/分

Breath

19 次/分

Systolic Pressure

115 mmHg

Diastolic Pressure

78 mmHg

Mean Arterial Pressure

92 mmHg

2.Blood Gas Analysis

Pcv-aCO2

-3.3 mmHg

DO2

619.2

VO2

194.8

Ca-vO2

40.6

5.2.、Arterial Blood Gas

PH value

7.35

PaO2

103 mmHg

PaCO2

35.3 mmHg

BE

-5.4 mmol/L

SaO2

98 %

Blood Lactic Acid Concentration

0.9 mmol/L

Oxygenation index (PaO2/FiO2)

257.5 mmHg

5.2.、Venous Blood Gas

PH value

7.31

PcvO2

60 mmHg

PcvCO2

32 mmHg

BE

-6 mmol/L

ScvO2

67.2 %

3.Vasoactive Agent and Fluid

Volume of input

5600 ml

Volume of output

3100 ml

Volume of urine

2860 ml

Ultrafiltration Volume

0 ml

Norepinephrine Dosage

30 mg

Dopamine Dosage

mg

Epinephrine Dosage

mg

Pituitrin Dosage

U

Dobutamine Dosage

mg

Milrinone Dosage

mg

Levosimendan

4.PiCCO Parameters

CVP

7 mmHg

cardiac output

4.8 L/min

cardiac index

2.93 L/min/m2

stroke volume

51.8 ml

Stroke Index

37.1 ml/m2

ITBVI

851 ml/m2

GEDVI

681 ml/m2

EVLWI

10.2 ml/kg

PVPI

2.2

SVRI

2122 DSm2/cm5

CFI

4

GEF

19 %

SVV

6 %

PPV

%

dPmax

492

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

4

LUS

5

B+ Zone

7.Inferior Vena Cava
5.7.1、

IVC(inspiratory phase)

17 mm

IVC(expiratory phase)

13 mm

Respiratory variations of inferior vena cavae diameter

24 %

5.7.2、

13 mm

12 mm

12 mm

10 mm

6.T48
1.Vital Signs

Temperature

36.8

Heart Rate

106 次/分

Breath

17 次/分

Systolic Pressure

122 mmHg

Diastolic Pressure

83 mmHg

Mean Arterial Pressure

97 mmHg

2.Blood Gas Analysis

Pcv-aCO2

-2.4 mmHg

DO2

602.5

VO2

164.7

Ca-vO2

36.0

6.2.、Arterial Blood Gas

PH value

7.43

PaO2

121 mmHg

PaCO2

34.4 mmHg

BE

-1.1 mmol/L

SaO2

99.1 %

Blood Lactic Acid Concentration

1 mmol/L

Oxygenation index (PaO2/FiO2)

302.5 mmHg

6.2.、Venous Blood Gas

PH value

7.41

PcvO2

45 mmHg

PcvCO2

32 mmHg

BE

-2 mmol/L

ScvO2

72.1 %

3.Vasoactive Agent and Fluid

Volume of input

6800 ml

Volume of output

4900 ml

Volume of urine

4500 ml

Ultrafiltration Volume

0 ml

Norepinephrine Dosage

35 mg

Dopamine Dosage

mg

Epinephrine Dosage

mg

Pituitrin Dosage

U

Dobutamine Dosage

mg

Milrinone Dosage

mg

Levosimendan

4.PiCCO Parameters

CVP

3 mmHg

cardiac output

4.57 L/min

cardiac index

2.79 L/min/m2

stroke volume

43.1 ml

Stroke Index

26.3 ml/m2

ITBVI

921 ml/m2

GEDVI

237 ml/m2

EVLWI

10.9 ml/kg

PVPI

2.1

SVRI

2697 DSm2/cm5

CFI

4

GEF

14 %

SVV

10 %

PPV

%

dPmax

575

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

6

LUS

5

B+ Zone

7.Inferior Vena Cava
6.7.1、

IVC(inspiratory phase)

18 mm

IVC(expiratory phase)

15 mm

Respiratory variations of inferior vena cavae diameter

17 %

6.7.2、

16 mm

14 mm

15 mm

12 mm

7.T72
1.Vital Signs

Temperature

37.1

Heart Rate

86 次/分

Breath

18 次/分

Systolic Pressure

129 mmHg

Diastolic Pressure

84 mmHg

Mean Arterial Pressure

100 mmHg

2.Blood Gas Analysis

Pcv-aCO2

0.3 mmHg

DO2

603.7

VO2

168.2

Ca-vO2

40.5

7.2.、Arterial Blood Gas

PH value

7.55

PaO2

96.7 mmHg

PaCO2

28.7 mmHg

BE

3.1 mmol/L

SaO2

98.5 %

Blood Lactic Acid Concentration

1.2 mmol/L

Oxygenation index (PaO2/FiO2)

241.8 mmHg

7.2.、Venous Blood Gas

PH value

7.52

PcvO2

46 mmHg

PcvCO2

29 mmHg

BE

2.1 mmol/L

ScvO2

71.1 %

3.Vasoactive Agent and Fluid

Volume of input

7200 ml

Volume of output

6807 ml

Volume of urine

6250 ml

Ultrafiltration Volume

0 ml

Norepinephrine Dosage

35 mg

Dopamine Dosage

mg

Epinephrine Dosage

mg

Pituitrin Dosage

U

Dobutamine Dosage

mg

Milrinone Dosage

mg

Levosimendan

4.PiCCO Parameters

CVP

9 mmHg

cardiac output

4.15 L/min

cardiac index

2.53 L/min/m2

stroke volume

48.3 ml

Stroke Index

29.4 ml/m2

ITBVI

283 ml/m2

GEDVI

626 ml/m2

EVLWI

9.4 ml/kg

PVPI

2.2

SVRI

2875 DSm2/cm5

CFI

4

GEF

19 %

SVV

5 %

PPV

%

dPmax

549

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

3

B+ Zone

7.Inferior Vena Cava
7.7.1、

IVC(expiratory phase)

17 mm

Respiratory variations of inferior vena cavae diameter

15 %

IVC(inspiratory phase)

12 mm

7.7.2、

13 mm

10 mm

12 mm

9 mm

8.Day 1
1.Cardiac Function Indices

NT-proBNP

6234 pg/ml

BNP

pg/ml

cTNI

0.025 ng/ml

Creatine kinase isoenzyme, CKMB

4 U/L

2.Renel Function Indices

Creatinine

54 umol/L

Urea nitrogen

4.4 mmol/l

MDRD

ml/min/1.73m2

Date of examination

yyyy-mm-dd

3.Blood Routine Tests

WBC

25.3 X10*9/L

neutrophilic granulocyte percentage

96.5 %

Hb

112 g/L

CRP

288.79 mg/L

Procalcitonin, PCT

ng/ml

Date of test

4.Sequential Organ Failure Assessment

Sequential Organ Failure Assessment

16

9.Day 2
1.Cardiac Function Indices

NT-proBNP

8001 pg/ml

BNP

pg/ml

cTNI

0.277 ng/ml

Creatine kinase isoenzyme, CKMB

10 U/L

2.Renel Function Indices

Creatinine

46 umol/L

Urea nitrogen

7.4 mmol/l

MDRD

ml/min/1.73m2

3.Blood Routine Tests

WBC

17 X10*9/L

neutrophilic granulocyte percentage

93 %

Hb

98 g/L

CRP

181.54 mg/L

Procalcitonin, PCT

0.048 ng/ml

4.Sequential Organ Failure Assessment

Sequential Organ Failure Assessment

12

10.Day 3
1.Cardiac Function Indices

NT-proBNP

15568 pg/ml

BNP

pg/ml

cTNI

0.331 ng/ml

Creatine kinase isoenzyme, CKMB

8 U/L

2.Renel Function Indices

Creatinine

52 umol/L

Urea nitrogen

12.7 mmol/L

MDRD

ml/min/1.73m2

3.Blood Routine Tests

WBC

13.7 X10*9/L

neutrophilic granulocyte percentage

90 %

Hb

98 g/L

CRP

132.1 mg/L

Procalcitonin, PCT

0.085 ng/ml

4.Sequential Organ Failure Assessment

Sequential Organ Failure Assessment

6

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

12

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

14

duration in ICU

5

duration of mechanical ventilation

56 小时

ICU expenses

34680

Continuous Renal Replacement Therapy

no

Continuous Renal Replacement Therapy

小时