Value of pulse-indicated continuous cardiac output monitoring in early fluid resuscitation of septic shock

Objective To evaluate pulse indicator continuous cardiac output monitoring(PICCO) application value in early fluid resuscitation of septic shock. Methods Forty patients with septic shock were randomly divided into treatment group(n=20) and control group(n=20). Based on the anti-infection and other basic therapy, the treatment group was treated according to the index of PICCO monitoring while the control group was treated according to the central venous pressure. The patients whose lactic acid level2 mmol/L and central venous oxygen saturation≥70% were recorded at 6 hours, 24 hours and volume of fluid resuscitation in 24 hours, norepinephrine dosage, the rate of pulmonary edema, mechanical ventilation time, ICU days, and 28 days mortality were measured. Results After fluid resuscitation for 6 hours, the differences of patients whose lactic acid level 2 mmol/L and central venous oxygen saturation ≥70% between two group were not statistically significant(χ2=0.11,0.11, P0.05)while it was statistically significant between two groups after the recovery 24 hours(χ2=2.75, 2.98,P 0.05). Compared with the control group, the volume of fluid resuscitation in 24 hours, norepinephrine dosage and the rate of pulmonary edema in PICCO group were significantly reduced(t=-2.33,-2.27, χ2=5.16, P0.05). But the mechanical ventilation time, ICU days and the 28 days mortality between two group had no significant difference(t=-1.97,-1.72, χ2=0.00, P0.05). Conclusion PICCO monitoring is accurate and reliable to assess patients' capacity status and guide the septic shock patients of the treatment with early fluid resuscitation and application of vasoactive drugs, and avoid pulmonary edema which caused by blind fluid infusion. But it can not significantly improve the duration of mechanical ventilation, ICU stay days, 28 days mortality and other indicators.