Organ Functions in Septic Patients Receiving Fluid Resuscitation Guided by Dynamic versus Static Parameters: A Randomized Controlled Trial
Thiti Sricharoenchai, MD¹, Nanthawan Okas, MD²,³
Affiliation : ¹ Division of Pulmonary and Critical Care Medicine, Department of Medicine, Faculty of Medicine, Thammasat University, Pathum Thani, Thailand; ² Department of Medicine, Faculty of Medicine, Thammasat University, Pathum Thani, Thailand; ³ Department of Medicine, Chawang Crown Prince Hospital, Nakhon Si Thammarat, Thailand
Background: A sequential organ failure assessment (SOFA) score of 2 or more reflects 10% mortality risk in septic patients. Although dynamic hemodynamic parameters can better predict fluid responsiveness than static parameters, standard methods have not been recommended.
Objective: The primary objective was to compare SOFA change from diagnosis to 72 hours between patients receiving dynamic ultrasound measurement of inferior vena cava (IVC) variation-guided and those receiving static central venous pressure (CVP)-guided fluid resuscitation. Secondary objectives were SOFA at 72 hours of sepsis and SOFA change from diagnosis to seven days, proportion of patients receiving vasopressor(s), 30-day vasopressor-free days (VFDs), and pulmonary edema within seven days.
Materials and Methods: A single-blinded randomized controlled trial was conducted in Thammasat University Hospital between September 2019 and March 2020. Septic patients were stratified by APACHE II score less than 25 or 25 and above, then randomized using blocks of 2 and 4 to dynamic IVC-guided or static CVP-guided.
Results: Of 104 patients, 52 in each group had comparable baseline characteristics. Median (IQR) SOFA changes during 72 hours were –2 (–3.5 to 5) versus –1 (–3 to 3.5) in dynamic IVC variation-guided vs. static CVP-guided, respectively, p=0.865. While medians (IQR) of SOFA at 72 hours and SOFA change during seven days were 5 (2 to 13) versus 7 (3.5 to 13), p=0.286, and –2 (–3.5 to 13) versus –3 (–4 to 1.5), p=0.180, those receiving vasopressor(s) were 82.7% versus 96.2%, p=0.026, median (IQR) 30-day VFDs were 28.5 (0 to 29.4) versus 22.5 (0 to 28.6), p=0.008; and pulmonary edema within seven days was 11.5% versus 13.5%, p=0.767.
Conclusion: Effects of dynamic IVC- and static CVP-guided fluid resuscitation in septic patients on SOFA score change from diagnosis to 72 hours and to seven days, 72-hour SOFA score, and pulmonary edema within seven days were not different, but those receiving vasopressor(s) may be lower, and 30-day VFDs may be higher in dynamic IVC variation-guided.
Received 20 November 2025 | Revised 4 March 2026 | Accepted 6 March 2026
DOI: 10.35755/jmedassocthai.2026.5.03908
Keywords : SOFA score; Ultrasound: Central venous pressure; Fluid resuscitation; Sepsis
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