Impact Of Early-Goal Directed Treatment On Perfusion And Injury Of Brain In Septic Shock Patients

Objective To evaluate the impact of early goal directed treatment (EGDT) on perfusion and metabolism of brain in septic shock patients.Methods(1) Patients:Early-staged (<24h from onset) septic shock patients who did not achieve the goal of EGDT were enrolled in the study.(2) Setting and observation:Eligible patients were divided into two groups according to the result of 6 hours’targets of EGDT. Patients who can reach the target of EGDT at 6h are belonging to EGDT group, the others are into Non-EGDT group. Hemodynamics, systemic oxygen metabolism, cerebral oxygen saturation and biomarkers of cerebral injury were monitored at time before EGDT (TO) and after 6 hours EGDT (Tl).(3) Measurement:PiCCO was used to measure hemodynamics and oxygen metabolism data, near-infrared spectroscopy (NIRS) technology was used to monitor the bilateral local cerebral oxygen saturation and serum NSE and S100 were measured to evaluate acute nervous system injury. Delirium at a week after patients enrolled was evaluated by CAM-ICU.Results(1) Demographic characteristics:Thirty-six patients with septic shock were included. The average age was 74.28±11.4 years. The acute physiology and chronic health score (APACHE) II was 25.11±9.5, SOFA score was 11.22±4.0.29 patients reached the EGDT goal after 6 hours and the remaining 7 patients failed.(2) Hemodynamics could be improved by EGDT:Compared with T0, HR decreased significantly in EGDT group at T1. MAP, CVP, CI, SVI were increased after EGDT (P <0.05). In NON-EGDT group, HR decreased and MAP increased after EGDT, but other indexes did not change significantly (P<0.05).(3) Cerebral perfusion could be increased by EGDT:Right and lift sides of regional cerebral oxygen saturation after EGDT are significantly higher than that before EGDT (P<0.05), but the cerebral oxygen saturation remain unchanged in the NON-EGDT group.(4) EGDT could alleviate acute brain injury:Compared with T0, the concentration of NSE and S100 had significantly decrease in EGDT group (T1). But in NON-EGDT group, there was no different between TO and T1.(5) Effect of EGDT on delirium at lweek:During the study,7 patients died or discharged within a week after enrollment. Among the remaining 29 patients,9 patients were diagnosed delirium, the incidence was about 31%. Incidence of delirium in EGDT group was markedly lower than that in NON-EGDT group (P< 0.05).Conclusion(1) Cerebral perfusion and brain injury could be improved by EGDT in patients with septic shock.(2) Compared with NSE, the prognostic value of S100β protein is higher in septic shock patients.