Application Of PICCO Monitor In Septic Shock Patients

Septic shock is a kind of organ dysfunction with serious circulatory disturbance and metabolic disorder of cell,which is caused by the imbalance of the body's response to infection.The illness is very dangerous in patients with septic shock,mortality was extremely high,which is one of the important causes of death in ICU patients.Early fluid resuscitation is still a key measure in the treatment of septic shock patients,with the increase of effective circulating blood volume to increase cardiac output,improve tissue perfusion,increase oxygen supply,improve prognosis.However,fluid resuscitation without real time monitor can lead to an increase in the volume load,aggravate the burden on the heart,which can cause pulmonary edema and increase mortality.Therefore,we need to explore a simple,rapid and effective means of monitoring fluid resuscitation guidance.This study aimed to investigate the value of pulse indicator continuous cardiac output(PICCO)in guiding the use of fluid resuscitation for patients with septic shock.Methods:A total of 61 patients with septic shock who were treated in our deparment from January 2014 to December 2016 were enrolled in the study and divided into EGDT group(30 cases)and PICCO group(31 cases).The EGDT group was treated with EGDT to guide the fluid resuscitation,while PICCO group was given the PICCO monitoring technique to guide the fluid resuscitation.The heart rate,mean arterial pressure,blood lactate,urine volume and the SOFA score of the two groups were recorded at the time of admission,12h after treatment,24h after treatment and 72h after treatment,and with the using of independent sample t test to compare the differences between the two groups.The mechanical ventilation time,ICU indwelling time,successful rate of fluid resuscitation and mortality rate of the 28 days were compared between two groups of patients.The 31 patients in PICCO group were divided into survival group and non-survival group,whose hemodynamic date and SOFA score at the beginning of treatment,SOFA score after treatment 24h,as well as 24h lactate clearance rate were recorded.Results:The MAP and urine volume in PICCO group were significantly higher than EGDT group after treatment of 12h,24h and 72h,(P<0.05),while HR,Lac,SOFA score were significantly lower than EGDT group(P<0.05).There was significant difference in mechanical ventilation time and indwelling time of ICU between PICCO group and EGDT group(P<0.05).The success rate of fluid resuscitation of PICCO group was significantly higher than that of EGDT group(P<0.05),and the mortality of PICCO group was significantly lower than that of EGDT group,the difference was statistically significant(P<0.05).We could get results through comparing the hemodynamic data between the survival group and the non-survival group at the beginning of treatment.The extravascular lung water index(EVLWI)in the survival group were significantly lower than those of non-survival group,while stroke peripheral vascular resistance index(SSVRI),pulse pressure and stroke index ratio(PP/SVI)in the survival group were significantly higher than those of non-survival group(P<0.05).The Oh SOFA and 24h SOFA of the non-survival group were significantly higher than those of the survival group(P<0.05).The 24h lactate clearance rate in survivors was significantly higher than those in non-survivors(P<0.05).By using Spearman Correlation Analysis Method,we can get a negative correlation between Oh PP/SVI and Oh SOFA score(r=-0.732,P<0.05),and a positively correlated between Oh PP/SVI and 24h lactate clearance rate(r=0.484,P<0.05).We can also get a negative correlation between Oh SSVRI and Oh SOFA score(r=-0.762,P<0.05),and a positively correlated between Oh SSVRI and 24h lactate clearance rate(r=0.40,P<0.05).Conclusion:The PICCO monitor has a significant effect on the fluid resuscitation for patients with septic shock,which could improve the success rate of early fluid resuscitation.The vascular paralysis of SSVRI,PP/SVI and SOFA score in septic shock patients have a negative correlation,while there is a positive correlation between Oh SSVRI,PP/SVI and 24h lactate clearance rate.The data is indicated to assess prognosis of patients with septic shock and was worthy of promotion in clinica pattern.