The Effect Of Fluid Management Guided By Critical Care Ultrasound Or Pulse Index Continuous Cardiac Output On The Prognosis Of Septic Shock Patients

BackgroundSepsis remains a major global health issue and fluid resuscitation is an essential therapy for septic shock.Pulse Index Continuous Cardiac Output(PICCO)is a commonly used invasive monitoring method that provides continuous and real-time monitoring of cardiac output,as well as several hemodynamic variables including Central Venous Pressure,Global End-Diastolic Volume Index,Intrathoracic Blood Volume Index,and Extravascular Lung Water.However,it cannot accurately estimate left and right heart function.Critical Care Ultrasound(CCUS),on the other hand,is a non-invasive and portable monitoring method that allows for repeated hemodynamic evaluations and assessment of not only cardiac function and Inferior Vena Cava width but also other organ functions.Both technologies are frequently utilized in clinical practice for monitoring fluid management,although the differences in patient outcomes resulting from these two fluid management methods in septic shock patients require further evaluation.Thus,we performed a retrospective study of data from our single-center to assess the differences in patient prognosis resulting from fluid management guided by CCUS versus PICCO,and to provide evidence-based recommendations for sepsis fluid resuscitation.ObjectiveTo evaluate the impact of fluid management guided by CCUS compared to PICCO,on the prognosis of patients with septic shock,in order to provide more comprehensive clinical guidance for sepsis fluid resuscitation.MethodsWe conducted a retrospective cohort study by selecting patients who underwent pulse index continuous cardiac output(PiCCO)operations from January 2015 to December 2016,and patients who underwent critical care ultrasound(CCUS)examination without PiCCO monitoring from January 2020 to December 2021 in our department.We used propensity score matching(PSM)method to adjust and balance the effects of confounding factors between the two groups.The variables included in the PSM analysis were age,gender,APACHE II score,SOFA score,heart rate,respiratory rate,mean arterial pressure,lactate,medical history,mechanical ventilation,and continuous renal replacement therapy(CRRT).The CCUS group and the PiCCO group were matched in a 1:1 ratio using a caliper of 0.02.We compared the 28-day mortality and survival analysis curves between the two groups,and compared the fluid balance in the first 72 hours between the two groups.ResultsA total of 703 septic shock patients were screened,with 171 patients included,including 79 patients in the CCUS group and 92 patients in the PiCCO group after matching.The two groups had no statistically significant differences in general clinical data,proportion of mechanical ventilation,proportion of CRRT,underlying diseases,and infection sites during hospitalization(p>0.05),and there was no statistically significant difference in the primary indicator 28-day mortality.The secondary indicators,including ICU stay,total hospitalization days,and fluid balance in the first 72 hours had no statistically significant difference between the two groups(p>0.05).However,there was a statistically significant difference in the fluid intake at 72 hours between the CCUS group(6309.00,5406.25-7481.75)and the PiCCO group(5297.30,4633.75-6541.75),with a p-value of 0.005,indicating that the CCUS group had a higher fluid intake in the first 72 hours.ConclusionIn septic shock patients,there was no statistically significant difference in 28-day mortality between fluid management guided by CCUS and PiCCO.However,septic shock patients guided by CCUS had higher fluid intake in the first 72 hours.