Efficacy of pulse-indicated continuous cardiac output for optimizing early goal-directed therapy in patients with septic shock

Objective To evaluate the efficacy of pulse-indicated continuous cardiac output (PiCCO) for optimizing early goal-directed therapy (EGDT) in patients with septic shock.Methods Forty patients with septic shock,aged 25-75 yr,with acute physiology and chronic health evaluation score of 10-40,were divided into 2 groups (n =20 each) using a random number table:conventional EGDT group (group C) and optimized EGDT guided by PiCCO group (P group).In group C,CVP was maintained at 8-12 mmHg,MAP ≥65 mmHg,and central venous oxygen saturation≥70％.In P group,a catheter was inserted into the femoral artery for PiCCO monitoring,fluid was replaced according to global end-diastolic volume index (GEDVI) combined with CVP and GEDVI was maintained between 650-800 ml/m2.The consumption of dobutamine was adjusted to maintain stroke volume index (SVI) between 40-60 ml/m2,and left ventricular systolic force index between 1 200-2 000 mmHg/s.The consumption of dopamine was adjusted to maintain peripheral vascular resistance index between 1 200-1 800 dyne· s· cm-5· m-2,and MAP ≥ 65 mmHg.EGDT achieving the standard at 6 h was recorded,and lactic acid level,arterial-venous carbon dioxide tension difference (Pv-aCO2) and urine volume were recorded at 6 h of resuscitation.At 6,24 and 48 h of resuscitation,the positive fluid balance and cumulative consumption of dopamine and dobutamine were recorded.Mechanical ventilation time,duration of ICU stay and survival rates within 28 days after start of resuscitation were recorded.Results Compared with group C,the lactic acid level and Pv-aCO2 were significantly decreased at 6 h of resuscitation,the positive fluid balance and cumulative consumption of dobutamine were increased at 6 and 24 h of resuscitation,the cumulative consumption of dopamine was decreased at 6,24 and 48 h of resuscitation,mechanical ventilation time and duration of ICU stay were shortened,and no significant change was found in EGDT achieving the standard at 6 h,urine volume and survival rate in group P.Conclusion PiCCO provides no optimization for EGDT in the patients with septic shock. Key words: Monitoring, physiologic ;  Shock, septic ;  Early goal-directed therapy