Organ functions in septic patients receiving fluid resuscitation guided by dynamic versus static parameters: a randomized controlled trial

<bold>Background:</bold> Sequential Organ Failure Assessment (SOFA) score ≥2 reflects 10% mortality risk in septic patients. Dynamic parameters can predict fluid responsiveness better than static parameters, but their use is not yet standard. This study aimed to compare SOFA change from diagnosis to 72 hours between patients receiving dynamic ultrasound (US) measurement of inferior vena cava (IVC) variation-guided and those receiving static central venous pressure (CVP)-guided fluid resuscitation as the primary objective. Secondary objectives were SOFA at 72 hours of sepsis and SOFA change from diagnosis to 7 days, proportion of patients receiving vasopressor, vasopressor duration, and pulmonary edema in 7 days. <bold>Methods:</bold> Single-blinded randomized controlled trial was conducted in Thammasat University Hospital between August 2019 and May 2020. Septic patients were stratified by APACHE-II <25 or ≥25, then randomized using blocks of 2 and 4 to dynamic IVC- or static CVP-guided. <bold>Results:</bold> Of 104 patients, 52 in each group had comparable baseline characteristics. Median(IQR) SOFA change during 72 hours were -2(−3.5 to 5) vs. -1(−3 to 3.5) in IVC vs. CVP, p=0.87. Median(IQR) SOFA at 72 hours and SOFA change during 7 days were 5(2 to 13) vs. 7(3.5 to 13), p=0.29, and -2(−3.5 to 13) vs. -3(−4 to 1.5), p=0.18. Vasopressor use was 82.7% vs. 96.2%, p=0.03, median(IQR) vasopressor durations were 0.9(0.7 to 1.6) vs. 1.5(1.1 to 2.8) days, p<0.01, and pulmonary edema in 7 days was 11.5% vs. 13.5%, p=0.77. <bold>Conclusions:</bold> Effects of IVC variation- and CVP-guided in septic patients on SOFA change were not different, but vasopressor use and duration were lower in IVC group.