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1.Basic Information
1.1.Basic Information

name

wjp

sex

male

age

58

hospital number

17020036

height

175 cm

weight

65 kg

BSA

1.79 m2

APACHEⅡ

31

Infection source

lung

date

2017/6/16 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

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

yes

no

no

no

no

2.T0
1.

yes

亚胺培南西司他丁

vasoactive agent

norepinephrine

60 min

60 min

65 min

2.vital signs

Temperature

34.6

Heart Rate

80 次/分

Breath

22 次/分

Systolic pressure (SP)

91 mmHg

Diastolic pressure

57 mmHg

mean arterial pressure

70 mmHg

3.Blood Gas Analysis

Pcv-aCO2

2 mmHg

DO2

886.45

VO2

74.95

Ca-vO2

10.96

2.3.、arterial blood gas analysis

pH value

7.49

PaO2

81 mmHg

PaCO2

32 mmHg

BE

0.5 mmol/L(±2.3mmol/L)

SaO2

96.80 %

Blood lactic acid concentration, LAC

2.7 mmol/L

Oxygenation index (PaO2/FiO2)

202.50 mmHg

2.3.、Central venous blood gas analysis

pH value

7.44

PcvO2

53 mmHg

PcvCO2

34 mmHg

BE

-1.2 mmol/L

ScvO2

88.60 %

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

0.133 μg/Kg/min

dopamine

no

Dopamine Dosage

μg/Kg/min

Dobutamine

No

Dobutamine Dosage

μg/Kg/min

5.PiCCO parameters

CVP

7 mmHg

cardiac output

6.89 L/min

cardiac index

3.85 L/min/m2

stroke volume

72 ml

Stroke Index

41 ml/m2

ITBVI

812 ml/m2

GEDVI

649 ml/m2

EVLWI

11 ml/kg

PVPI

2.4

SVRI

1549 DSm2/cm5

CFI

5.7

GEF

23.00 %

SVV

11.00 %

PPV

7 %

dPmax

1833

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

0

LUS

2

B+ Zone

8.inferior vena cava
2.8.1.、

IVC(inspiratory phase)

17.7 mm

IVC(expiratory phase)

15.4 mm

respiratory variations of inferior vena cavae diameter

13.90 %

2.8.2.、

mm

mm

mm

mm

3.T6
7..Inferior Vena Cava
3.7..1、

IVC(inspiratory phase)

17.7 mm

IVC(expiratory phase)

14.6 mm

Respiratory variations of inferior vena cavae diameter

19.20 %

3.7..2、

mm

mm

mm

mm

1..Vital Signs

Temperature

36

Heart Rate

103 次/分

Breath

16 次/分

Systolic Pressure

167 mmHg

Diastolic Pressure

70 mmHg

Mean Arterial Pressure

108 mmHg

2..Blood Gas Analysis

Pcv-aCO2

2.00 mmHg

DO2

851.96

VO2

53.81

Ca-vO2

7.97

3.2..、Arterial Blood Gases

PH value

7.48

PaO2

82 mmHg

PaCO2

32 mmHg

BE

0.5 mmol/L

SaO2

94.80 %

Blood Lactic Acid Concentration

2.7 mmol/L

Oxygenation index (PaO2/FiO2)

205.00 mmHg

3.2..、Venous Blood Gas

PH value

7.44

PcvO2

51 mmHg

PcvCO2

34 mmHg

BE

-1.3 mmol/L

ScvO2

88.80 %

3..Vasoactive Agent and Fluid

Volume of input

836 ml

Volume of output

600 ml

Volume of urine

600 ml

Ultrafiltration Volume

0 ml

Norepinephrine Dosage

1.44 mg

Dopamine Dosage

mg

Epinephrine Dosage

mg

Pituitrin Dosage

U

Dobutamine Dosage

mg

Milrinone Dosage

mg

Levosimendan

no

4..PiCCO Parameters

CVP

7 mmHg

cardiac output

6.83 L/min

cardiac index

3.78 L/min/m2

stroke volume

75 ml

Stroke Index

42 ml/m2

ITBVI

805 ml/m2

GEDVI

620 ml/m2

EVLWI

11 ml/kg

PVPI

2.6

SVRI

1530 DSm2/cm5

CFI

5.8

GEF

24.00 %

SVV

6.00 %

PPV

5 %

dPmax

1800

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

0

LUS

2

B+ Zone

4.T12
1..Vital Signs

Temperature

37.4

Heart Rate

120 次/分

Breath

23 次/分

Systolic Pressure

130 mmHg

Diastolic Pressure

50 mmHg

Mean Arterial Pressure

88 mmHg

2..Blood Gas Analysis

Pcv-aCO2

7.00 mmHg

DO2

787.38

VO2

115.59

Ca-vO2

17.04

4.2..、Arterial Blood Gas

PH value

7.41

PaO2

136 mmHg

PaCO2

36 mmHg

BE

-2.1 mmol/L

SaO2

99.10 %

Blood Lactic Acid Concentration

1.1 mmol/L

Oxygenation index (PaO2/FiO2)

340.00 mmHg

4.2..、Venous Blood Gas

PH value

7.21

PcvO2

63 mmHg

PcvCO2

43 mmHg

BE

-10.2 mmol/L

ScvO2

84.50 %

3..Vasoactive Agent and Fluid

Volume of input

1913 ml

Volume of output

1650 ml

Volume of urine

1650 ml

Ultrafiltration Volume

0 ml

Norepinephrine Dosage

1.44 mg

Dopamine Dosage

mg

Epinephrine Dosage

mg

Pituitrin Dosage

U

Dobutamine Dosage

mg

Milrinone Dosage

mg

Levosimendan

no

4..PiCCO Parameters

CVP

7 mmHg

cardiac output

6.87 L/min

cardiac index

3.84 L/min/m2

stroke volume

77 ml

Stroke Index

43 ml/m2

ITBVI

760 ml/m2

GEDVI

607 ml/m2

EVLWI

11 ml/kg

PVPI

2.8

SVRI

1576 DSm2/cm5

CFI

6

GEF

25.00 %

SVV

5.00 %

PPV

3 %

dPmax

1763

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

0

LUS

2

B+ Zone

7..Inferior Vena Cava
4.7..1、

IVC(inspiratory phase)

16.9 mm

IVC(expiratory phase)

14.6 mm

Respiratory variations of inferior vena cavae diameter

14.60 %

4.7..2、

mm

mm

mm

mm

5.T24
1.Vital Signs

Temperature

37.2

Heart Rate

114 次/分

Breath

18 次/分

Systolic Pressure

144 mmHg

Diastolic Pressure

67 mmHg

Mean Arterial Pressure

94 mmHg

2.Blood Gas Analysis

Pcv-aCO2

6.00 mmHg

DO2

872.40

VO2

75.24

Ca-vO2

9.24

5.2.、Arterial Blood Gas

PH value

7.45

PaO2

147 mmHg

PaCO2

38 mmHg

BE

1.2 mmol/L

SaO2

99.30 %

Blood Lactic Acid Concentration

1.2 mmol/L

Oxygenation index (PaO2/FiO2)

367.50 mmHg

5.2.、Venous Blood Gas

PH value

7.36

PcvO2

63 mmHg

PcvCO2

44 mmHg

BE

-1.3 mmol/L

ScvO2

90.70 %

3.Vasoactive Agent and Fluid

Volume of input

4443 ml

Volume of output

2750 ml

Volume of urine

2750 ml

Ultrafiltration Volume

0 ml

Norepinephrine Dosage

3.2 mg

Dopamine Dosage

mg

Epinephrine Dosage

mg

Pituitrin Dosage

U

Dobutamine Dosage

mg

Milrinone Dosage

mg

Levosimendan

no

4.PiCCO Parameters

CVP

10 mmHg

cardiac output

8.37 L/min

cardiac index

4.67 L/min/m2

stroke volume

75 ml

Stroke Index

42 ml/m2

ITBVI

688 ml/m2

GEDVI

551 ml/m2

EVLWI

12 ml/kg

PVPI

3.2

SVRI

1379 DSm2/cm5

CFI

8.1

GEF

28.00 %

SVV

7.00 %

PPV

3 %

dPmax

2445

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

0

LUS

2

B+ Zone

7.Inferior Vena Cava
5.7.1、

IVC(inspiratory phase)

17.4 mm

IVC(expiratory phase)

15.3 mm

Respiratory variations of inferior vena cavae diameter

12.84 %

5.7.2、

mm

mm

mm

mm

6.T48
1.Vital Signs

Temperature

37.4

Heart Rate

114 次/分

Breath

21 次/分

Systolic Pressure

130 mmHg

Diastolic Pressure

66 mmHg

Mean Arterial Pressure

9 mmHg

2.Blood Gas Analysis

Pcv-aCO2

1.00 mmHg

DO2

941.05

VO2

93.68

Ca-vO2

10.24

6.2.、Arterial Blood Gas

PH value

7.48

PaO2

84 mmHg

PaCO2

40 mmHg

BE

4.9 mmol/L

SaO2

97.20 %

Blood Lactic Acid Concentration

1.2 mmol/L

Oxygenation index (PaO2/FiO2)

210.00 mmHg

6.2.、Venous Blood Gas

PH value

7.46

PcvO2

50 mmHg

PcvCO2

41 mmHg

BE

4.3 mmol/L

ScvO2

87.50 %

3.Vasoactive Agent and Fluid

Volume of input

6353 ml

Volume of output

5850 ml

Volume of urine

5850 ml

Ultrafiltration Volume

0 ml

Norepinephrine Dosage

4.22 mg

Dopamine Dosage

mg

Epinephrine Dosage

mg

Pituitrin Dosage

U

Dobutamine Dosage

mg

Milrinone Dosage

mg

Levosimendan

no

4.PiCCO Parameters

CVP

12 mmHg

cardiac output

9.24 L/min

cardiac index

5.16 L/min/m2

stroke volume

89 ml

Stroke Index

50 ml/m2

ITBVI

825 ml/m2

GEDVI

660 ml/m2

EVLWI

9 ml/kg

PVPI

2

SVRI

1307 DSm2/cm5

CFI

7.5

GEF

28.00 %

SVV

4.00 %

PPV

2 %

dPmax

1864

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

0

LUS

2

B+ Zone

7.Inferior Vena Cava
6.7.1、

IVC(inspiratory phase)

17.7 mm

IVC(expiratory phase)

15.4 mm

Respiratory variations of inferior vena cavae diameter

13.90 %

6.7.2、

mm

mm

mm

mm

7.T72
1.Vital Signs

Temperature

38.2

Heart Rate

116 次/分

Breath

20 次/分

Systolic Pressure

130 mmHg

Diastolic Pressure

65 mmHg

Mean Arterial Pressure

90 mmHg

2.Blood Gas Analysis

Pcv-aCO2

4.00 mmHg

DO2

942.81

VO2

70.60

Ca-vO2

7.36

7.2.、Arterial Blood Gas

PH value

7.49

PaO2

61 mmHg

PaCO2

35 mmHg

BE

2.6 mmol/L

SaO2

93.30 %

Blood Lactic Acid Concentration

2.3 mmol/L

Oxygenation index (PaO2/FiO2)

152.50 mmHg

7.2.、Venous Blood Gas

PH value

7.47

PcvO2

47 mmHg

PcvCO2

39 mmHg

BE

3.8 mmol/L

ScvO2

86.30 %

3.Vasoactive Agent and Fluid

Volume of input

9603 ml

Volume of output

9750 ml

Volume of urine

9750 ml

Ultrafiltration Volume

0 ml

Norepinephrine Dosage

7.1 mg

Dopamine Dosage

mg

Epinephrine Dosage

mg

Pituitrin Dosage

U

Dobutamine Dosage

mg

Milrinone Dosage

mg

Levosimendan

no

4.PiCCO Parameters

CVP

12 mmHg

cardiac output

9.65 L/min

cardiac index

5.39 L/min/m2

stroke volume

84 ml

Stroke Index

48 ml/m2

ITBVI

1538 ml/m2

GEDVI

1230 ml/m2

EVLWI

11 ml/kg

PVPI

2.4

SVRI

1325 DSm2/cm5

CFI

7.7

GEF

27.00 %

SVV

6.00 %

PPV

5 %

dPmax

2034

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

0

LUS

2

B+ Zone

7.Inferior Vena Cava
7.7.1、

IVC(expiratory phase)

17.5 mm

Respiratory variations of inferior vena cavae diameter

14.6 %

IVC(inspiratory phase)

18.07 mm

7.7.2、

mm

mm

mm

mm

8.Day 1
1.Cardiac Function Indices

NT-proBNP

pg/ml

BNP

94 pg/ml

cTNI

<0.012 ng/ml

Creatine kinase isoenzyme, CKMB

27.4 U/L

2.Renel Function Indices

Creatinine

75 umol/L

Urea nitrogen

4.1 mmol/l

MDRD

92.778 ml/min/1.73m2

Date of examination

yyyy-mm-dd

3.Blood Routine Tests

WBC

10.9 X10*9/L

neutrophilic granulocyte percentage

95.4 %

Hb

g/L

CRP

206 mg/L

Procalcitonin, PCT

0.385 ng/ml

Date of test

4.Sequential Organ Failure Assessment

Sequential Organ Failure Assessment

9

9.Day 2
1.Cardiac Function Indices

NT-proBNP

pg/ml

BNP

146 pg/ml

cTNI

<0.012 ng/ml

Creatine kinase isoenzyme, CKMB

17.5 U/L

2.Renel Function Indices

Creatinine

61 umol/L

Urea nitrogen

2.7 mmol/l

MDRD

117.76 ml/min/1.73m2

3.Blood Routine Tests

WBC

7.1 X10*9/L

neutrophilic granulocyte percentage

97.2 %

Hb

g/L

CRP

237 mg/L

Procalcitonin, PCT

0.634 ng/ml

4.Sequential Organ Failure Assessment

Sequential Organ Failure Assessment

8

10.Day 3
1.Cardiac Function Indices

NT-proBNP

pg/ml

BNP

140 pg/ml

cTNI

<0.012 ng/ml

Creatine kinase isoenzyme, CKMB

20.1 U/L

2.Renel Function Indices

Creatinine

62 umol/L

Urea nitrogen

301 mmol/L

MDRD

115.571 ml/min/1.73m2

3.Blood Routine Tests

WBC

5.6 X10*9/L

neutrophilic granulocyte percentage

91.7 %

Hb

g/L

CRP

134 mg/L

Procalcitonin, PCT

0.511 ng/ml

4.Sequential Organ Failure Assessment

Sequential Organ Failure Assessment

9

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

28

Complication

no

4.2.prognosis

prognosis

discharge

28-day mortality

no

survival time(day)

death time

yyyy/mm/dd

diagnosis of death

length of stay

13

duration in ICU

13

duration of mechanical ventilation

312 小时

ICU expenses

61141.37

Continuous Renal Replacement Therapy

no

Continuous Renal Replacement Therapy

小时