Data viva: a cardiac output monitor dataset in shock

A CICM cross-table data viva on reading a cardiac output dataset. The candidate interprets the cardiac index, the stroke volume variation, the global end-diastolic volume and the extravascular lung water, applies a passive leg raise to test responsiveness, and judges whether the patient needs fluid, a vasopressor, or an inotrope — the bedside skill that the fluid-responsiveness and EVLW evidence made central.

Prompt

A cardiac output monitoring dataset from a transpulmonary thermodilution device in a shocked patient, before and after a passive leg raise — interpret the numbers, judge fluid responsiveness, and state what you would do.

Stimulus

A 60-year-old man is in septic shock, passively ventilated in sinus rhythm at a tidal volume of 8 mL/kg, on noradrenaline. You are shown the transpulmonary thermodilution dataset, at baseline and during a passive leg raise:

^[1]

Variable	Baseline	During passive leg raise	Normal
Cardiac index	3.1 L/min/m²	3.6 L/min/m²	2.5–4.0
Stroke volume variation	14%	9%	less than 10%
Global end-diastolic volume index	680 mL/m²	720 mL/m²	650–800
Extravascular lung water	14 mL/kg (predicted)	—	3–7
Central venous oxygen saturation	67%	—	at least 70%
Mean arterial pressure	64 mmHg	68 mmHg	at least 65

^[1]

Interpret the dataset, judge whether he is fluid-responsive, and state what you would do.^[3]

References5Show

[1]Michard F, Boussat S, Chemla D, et al. Relation Between Respiratory Changes in Arterial Pulse Pressure and Fluid Responsiveness in Septic Patients With Acute Circulatory Failure. American Journal of Respiratory and Critical Care Medicine, 2000.PMID 10903232
[2]Monnet X, Rienzo M, Osman D, et al. Passive Leg Raising Predicts Fluid Responsiveness in the Critically Ill. Critical Care Medicine, 2006.PMID 16540963
[3]Sakka SG, Klein M, Reinhart K, Meier-Hellmann A. Prognostic Value of Extravascular Lung Water in Critically Ill Patients. Chest, 2002.PMID 12475851
[4]Bersten AD, Soni N (eds) Oh's Intensive Care Manual. 8th edition, Elsevier, 2018.
[5]Marino PL The ICU Book. 4th edition, Lippincott Williams & Wilkins, 2014.

Data viva: a cardiac output monitor dataset in shock

Stimulus

Variable	Baseline	During passive leg raise	Normal
Cardiac index	3.1 L/min/m²	3.6 L/min/m²	2.5–4.0
Stroke volume variation	14%	9%	less than 10%
Global end-diastolic volume index	680 mL/m²	720 mL/m²	650–800
Extravascular lung water	14 mL/kg (predicted)	—	3–7
Central venous oxygen saturation	67%	—	at least 70%
Mean arterial pressure	64 mmHg	68 mmHg	at least 65

Interpret the dataset, judge whether he is fluid-responsive, and state what you would do.^[3]

References5Show

[1]Michard F, Boussat S, Chemla D, et al. Relation Between Respiratory Changes in Arterial Pulse Pressure and Fluid Responsiveness in Septic Patients With Acute Circulatory Failure. American Journal of Respiratory and Critical Care Medicine, 2000.PMID 10903232
[2]Monnet X, Rienzo M, Osman D, et al. Passive Leg Raising Predicts Fluid Responsiveness in the Critically Ill. Critical Care Medicine, 2006.PMID 16540963
[3]Sakka SG, Klein M, Reinhart K, Meier-Hellmann A. Prognostic Value of Extravascular Lung Water in Critically Ill Patients. Chest, 2002.PMID 12475851
[4]Bersten AD, Soni N (eds) Oh's Intensive Care Manual. 8th edition, Elsevier, 2018.
[5]Marino PL The ICU Book. 4th edition, Lippincott Williams & Wilkins, 2014.