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1.Basic Information
1.1.Basic Information

name

lbj

sex

female

age

72

hospital number

858043

height

158 cm

weight

65 kg

BSA

1.66 m2

APACHEⅡ

18

Infection source

lung

date

2017/12/26 年/月/日

Sequential Organ Failure Assessment

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

yes

no

no

no

no

2.T0
1.

yes

比阿培南0.6g ivgtt q12h

vasoactive agent

norepinephrine

100 min

180 min

160 min

2.vital signs

Temperature

37.2

Heart Rate

75 次/分

Breath

18 次/分

Systolic pressure (SP)

108 mmHg

Diastolic pressure

53 mmHg

mean arterial pressure

68 mmHg

3.Blood Gas Analysis

Pcv-aCO2

4.4 mmHg

DO2

394.73

VO2

7.75

Ca-vO2

2.43

2.3.、arterial blood gas analysis

pH value

7.45

PaO2

62.2 mmHg

PaCO2

33.6 mmHg

BE

-0.4 mmol/L(±2.3mmol/L)

SaO2

91.5 %

Blood lactic acid concentration, LAC

2.6 mmol/L

Oxygenation index (PaO2/FiO2)

155.50 mmHg

2.3.、Central venous blood gas analysis

pH value

7.31

PcvO2

41.7 mmHg

PcvCO2

38 mmHg

BE

-6.5 mmol/L

ScvO2

89.70 %

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

0.21 μg/Kg/min

dopamine

no

Dopamine Dosage

μg/Kg/min

Dobutamine

No

Dobutamine Dosage

μg/Kg/min

5.PiCCO parameters

CVP

10 mmHg

cardiac output

3.28 L/min

cardiac index

1.98 L/min/m2

stroke volume

43.7 ml

Stroke Index

36.3 ml/m2

ITBVI

736 ml/m2

GEDVI

589 ml/m2

EVLWI

7.9 ml/kg

PVPI

2

SVRI

3237 DSm2/cm5

CFI

3

GEF

18 %

SVV

4 %

PPV

%

dPmax

690

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

2

LUS

8

B+ Zone

8.inferior vena cava
2.8.1.、

IVC(inspiratory phase)

23 mm

IVC(expiratory phase)

20 mm

respiratory variations of inferior vena cavae diameter

13.95 %

2.8.2.、

mm

mm

mm

mm

3.T6
7..Inferior Vena Cava
3.7..1、

IVC(inspiratory phase)

20 mm

IVC(expiratory phase)

18 mm

Respiratory variations of inferior vena cavae diameter

10.53 %

3.7..2、

mm

mm

mm

mm

1..Vital Signs

Temperature

36.8

Heart Rate

76 次/分

Breath

16 次/分

Systolic Pressure

126 mmHg

Diastolic Pressure

72 mmHg

Mean Arterial Pressure

85 mmHg

2..Blood Gas Analysis

Pcv-aCO2

8.80 mmHg

DO2

340.09

VO2

12.8

Ca-vO2

4.85

3.2..、Arterial Blood Gases

PH value

7.46

PaO2

69.1 mmHg

PaCO2

29 mmHg

BE

-2.8 mmol/L

SaO2

95.5 %

Blood Lactic Acid Concentration

2.8 mmol/L

Oxygenation index (PaO2/FiO2)

172.75 mmHg

3.2..、Venous Blood Gas

PH value

7.49

PcvO2

45.1 mmHg

PcvCO2

37.8 mmHg

BE

-1.8 mmol/L

ScvO2

91.9 %

3..Vasoactive Agent and Fluid

Volume of input

1290 ml

Volume of output

1050 ml

Volume of urine

1000 ml

Ultrafiltration Volume

0 ml

Norepinephrine Dosage

2 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

2.68 L/min

cardiac index

1.61 L/min/m2

stroke volume

35.3 ml

Stroke Index

21.2 ml/m2

ITBVI

749 ml/m2

GEDVI

600 ml/m2

EVLWI

9.1 ml/kg

PVPI

2.3

SVRI

4804 DSm2/cm5

CFI

3

GEF

14 %

SVV

5 %

PPV

%

dPmax

653

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

8

B+ Zone

4.T12
1..Vital Signs

Temperature

37.2

Heart Rate

76 次/分

Breath

18 次/分

Systolic Pressure

112 mmHg

Diastolic Pressure

62 mmHg

Mean Arterial Pressure

78 mmHg

2..Blood Gas Analysis

Pcv-aCO2

1.3 mmHg

DO2

316.74

VO2

11.25

Ca-vO2

4.69

4.2..、Arterial Blood Gas

PH value

7.41

PaO2

73 mmHg

PaCO2

28.7 mmHg

BE

-2.2 mmol/L

SaO2

95.60 %

Blood Lactic Acid Concentration

1.2 mmol/L

Oxygenation index (PaO2/FiO2)

182.5 mmHg

4.2..、Venous Blood Gas

PH value

7.45

PcvO2

60 mmHg

PcvCO2

30 mmHg

BE

-3.8 mmol/L

ScvO2

92.2 %

3..Vasoactive Agent and Fluid

Volume of input

1500 ml

Volume of output

1200 ml

Volume of urine

1200 ml

Ultrafiltration Volume

0 ml

Norepinephrine Dosage

8 mg

Dopamine Dosage

mg

Epinephrine Dosage

mg

Pituitrin Dosage

U

Dobutamine Dosage

mg

Milrinone Dosage

10 mg

Levosimendan

no

4..PiCCO Parameters

CVP

8 mmHg

cardiac output

2.42 L/min

cardiac index

1.46 L/min/m2

stroke volume

31.8 ml

Stroke Index

19.2 ml/m2

ITBVI

669 ml/m2

GEDVI

535 ml/m2

EVLWI

9.8 ml/kg

PVPI

2.8

SVRI

4772 DSm2/cm5

CFI

3

GEF

14 %

SVV

4 %

PPV

%

dPmax

652

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

1

LUS

6

B+ Zone

7..Inferior Vena Cava
4.7..1、

IVC(inspiratory phase)

19 mm

IVC(expiratory phase)

17 mm

Respiratory variations of inferior vena cavae diameter

11.11 %

4.7..2、

mm

mm

mm

mm

5.T24
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

2.9 mmHg

DO2

0

VO2

0

Ca-vO2

12.95

5.2.、Arterial Blood Gas

PH value

7.48

PaO2

80.4 mmHg

PaCO2

25.2 mmHg

BE

-4 mmol/L

SaO2

97.10 %

Blood Lactic Acid Concentration

1 mmol/L

Oxygenation index (PaO2/FiO2)

201.0 mmHg

5.2.、Venous Blood Gas

PH value

7.48

PcvO2

47.8 mmHg

PcvCO2

28.1 mmHg

BE

-1.8 mmol/L

ScvO2

87.7 %

3.Vasoactive Agent and Fluid

Volume of input

1720 ml

Volume of output

1700 ml

Volume of urine

1750 ml

Ultrafiltration Volume

0 ml

Norepinephrine Dosage

8 mg

Dopamine Dosage

mg

Epinephrine Dosage

mg

Pituitrin Dosage

U

Dobutamine Dosage

mg

Milrinone Dosage

15 mg

Levosimendan

no

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
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

4.40 mmHg

DO2

0

VO2

0

Ca-vO2

13.01

6.2.、Arterial Blood Gas

PH value

7.48

PaO2

99.8 mmHg

PaCO2

25.7 mmHg

BE

-3.8 mmol/L

SaO2

98.6 %

Blood Lactic Acid Concentration

1.1 mmol/L

Oxygenation index (PaO2/FiO2)

249.50 mmHg

6.2.、Venous Blood Gas

PH value

7.52

PcvO2

50.1 mmHg

PcvCO2

30.1 mmHg

BE

-2 mmol/L

ScvO2

89.10 %

3.Vasoactive Agent and Fluid

Volume of input

3677 ml

Volume of output

5520 ml

Volume of urine

5450 ml

Ultrafiltration Volume

0 ml

Norepinephrine Dosage

12 mg

Dopamine Dosage

mg

Epinephrine Dosage

mg

Pituitrin Dosage

U

Dobutamine Dosage

mg

Milrinone Dosage

20 mg

Levosimendan

no

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

5.50 mmHg

DO2

0

VO2

0

Ca-vO2

11.91

7.2.、Arterial Blood Gas

PH value

7.52

PaO2

106 mmHg

PaCO2

27.5 mmHg

BE

-0.1 mmol/L

SaO2

98.90 %

Blood Lactic Acid Concentration

1.5 mmol/L

Oxygenation index (PaO2/FiO2)

265 mmHg

7.2.、Venous Blood Gas

PH value

7.49

PcvO2

67 mmHg

PcvCO2

33 mmHg

BE

1.1 mmol/L

ScvO2

90.10 %

3.Vasoactive Agent and Fluid

Volume of input

5266 ml

Volume of output

8380 ml

Volume of urine

8250 ml

Ultrafiltration Volume

0 ml

Norepinephrine Dosage

12 mg

Dopamine Dosage

mg

Epinephrine Dosage

mg

Pituitrin Dosage

U

Dobutamine Dosage

mg

Milrinone Dosage

20 mg

Levosimendan

no

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

pg/ml

cTNI

7.06 ng/ml

Creatine kinase isoenzyme, CKMB

52 U/L

2.Renel Function Indices

Creatinine

119 umol/L

Urea nitrogen

11.6 mmol/l

MDRD

ml/min/1.73m2

Date of examination

yyyy-mm-dd

3.Blood Routine Tests

WBC

10.3 X10*9/L

neutrophilic granulocyte percentage

91.1 %

Hb

g/L

CRP

0.5 mg/L

Procalcitonin, PCT

0.136 ng/ml

Date of test

4.Sequential Organ Failure Assessment

Sequential Organ Failure Assessment

15

9.Day 2
1.Cardiac Function Indices

NT-proBNP

pg/ml

BNP

pg/ml

cTNI

14.912 ng/ml

Creatine kinase isoenzyme, CKMB

19 U/L

2.Renel Function Indices

Creatinine

114 umol/L

Urea nitrogen

9.8 mmol/l

MDRD

ml/min/1.73m2

3.Blood Routine Tests

WBC

8 X10*9/L

neutrophilic granulocyte percentage

90.9 %

Hb

g/L

CRP

64.54 mg/L

Procalcitonin, PCT

ng/ml

4.Sequential Organ Failure Assessment

Sequential Organ Failure Assessment

13

10.Day 3
1.Cardiac Function Indices

NT-proBNP

pg/ml

BNP

pg/ml

cTNI

4.75 ng/ml

Creatine kinase isoenzyme, CKMB

8 U/L

2.Renel Function Indices

Creatinine

111 umol/L

Urea nitrogen

13.4 mmol/L

MDRD

ml/min/1.73m2

3.Blood Routine Tests

WBC

904 X10*9/L

neutrophilic granulocyte percentage

94.1 %

Hb

g/L

CRP

231.89 mg/L

Procalcitonin, PCT

ng/ml

4.Sequential Organ Failure Assessment

Sequential Organ Failure Assessment

8

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

department transference

28-day mortality

no

survival time(day)

death time

yyyy/mm/dd

diagnosis of death

length of stay

28

duration in ICU

7

duration of mechanical ventilation

150 小时

ICU expenses

56800

Continuous Renal Replacement Therapy

no

Continuous Renal Replacement Therapy

0 小时