4. Materials and Methods
Sepsis, stroke, ARDS, organ dysfunction, septic shock, AKI, sepsis
SEPSIS, HEART, STROKE, SEPTIC SHOCK, SEPSIS, ARDS
The study was performed in a 1000-bed university hospital (City Hospital #1 of Arkhangelsk, Russia). The study protocol and the informed consent form were approved by the Ethics Committee of the Northern State Medical University (Arkhangelsk, Russia). Written informed consent was obtained from the patient or, when unconscious, from the patient’s next of kin. Sixty-five adult patients with sepsis and ARDS were screened for enrollment into a prospective randomized study from 2014 to 2019. Sepsis and ARDS were diagnosed according to the third international definition of sepsis and septic shock and the Berlin definition of ARDS, respectively [At the study baseline, the enrolled patients were randomly assigned to a strategy of fluid therapy using either extravascular lung water index (EVLWI)-oriented (In all patients, we catheterized the internal jugular or the subclavian vein with a triple-lumen central venous catheter (Certofix, B|Braun, Melsungen, Germany) and the femoral artery with a thermistor-tipped arterial catheter (5F, PV2015L20, Pulsion Medical Systems, Munich, Germany). The arterial blood pressure was recorded from a side port of the catheter. Hemodynamic monitoring was carried out using the method of transpulmonary thermodilution (PiCCOThe target fluid balance was achieved by continuous infusion of furosemide with an initial dose of 0.07 mcg/kg/h and a minimal duration of 12 h. In case of failure to reach a negative fluid balance by means of diuretics in patients with AKI and septic shock, we started controlled ultrafiltration using continuous veno-venous hemofiltration (CVVH, multiFiltrate, Fresenius Medical Care, Bad Homburg, Germany). For fluid replacement, if necessary, we administered balanced crystalloid solutions (Sterofundin Iso/G5, B|Braun, Melsungen, Germany) with an initial infusion rate of 6–7 mL/kg/h.Heart rate (HR), MAP, cardiac index (CI), GEDVI, EVLWI, pulmonary vascular permeability index (PVPI), central venous pressure (CVP), systemic vascular resistance index (SVRI), pulse pressure variation (PPV), and stroke volume variation (SVV) were assessed using transpulmonary thermodilution and arterial pulse contour analysis. During the study, we also assessed blood gases (ABL Flex 800 Radiometer, Copenhagen, Denmark) and biochemical parameters (Random Access A-25, BioSystems, Barcelona, Spain). All measurements were performed at baseline, at 24, and at 48 h of the goal-directed de-escalation.The clinical characteristics assessed during the study included fluid balance, doses of vasopressors, duration of mechanical ventilation, and length of ICU and hospital stays. We evaluated the severity of organ dysfunction at the study entry and at 48 h according to the Sequential Organ Failure Score (SOFA) [The results of the study were partially published in Russian [