Background:

Mortality associated with septic shock is still elevated, appropriate resuscitation and intravascular volume optimization are the cornerstones in the treatment. Optimization requires invasive monitoring and static measurements; therefore, a non-invasive, fast and dynamic method to make all measures is needed. Thoracic fluid content (TFC) by thoracic bioimpedance is a monitoring system that fulfills the requirements: non-invasive, of easy placement and dynamic.

Methods:

Sixty patients were enrolled in the study and divided into two groups of 30 subjects each; all of them were admitted with a septic shock diagnosis in the ICU. Group F was formed by patients in whom TFC was measured by thoracic bioimpedance in order to guide intravascular volume optimization; Group C patients were optimized following the «Surviving Sepsis Campaign Guidelines». We recorded mortality at ICU discharge and at 28 days, length of mechanical ventilation and ICU length of stay.

Results:

Based on TFC, group F obtained a faster and higher mean blood pressure (MBP), increasing up to 42.5% at 6 hours, compared to Group C, where MBP rose only 19.5% at 6 hours (p: < 0.05). Regarding lactate clearance, group F obtained a total clearance of 54.4% and 66.6% at six and 12 hours; in group C, clearance came up only to 25.3% and 35.8% at six and 12 hours (p: 0.001). A higher mortality at ICU discharge was observed in group C, with 33.4% versus 26.7% (p: 0.001) in group F, 28 day mortality was 36.5% and 27.8% (p: 0.003) in groups C and F, respectively.

Conclusion:

Measurement of thoracic fluid content by thoracic bioimpedance is effective when optimizing intravascular volume in septic shock.

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