Effect Of Different Levels Of Hemodynamic Monitoring On Strategy Of Circulation Resuscitation For ICU Patients With Shock

Objective The present study was to investigate the relationship between hemodynamic monitoring and the strategy of circulation resuscitation for patients with shock, in order to provide the data for the choice of hemodynamic monitoring methods in the patients suffering from shock.Methods This work was a retrospective study. A total 96 patients with shock was divided into two groups according to the employment of different hemodynamic monitoring methods. The clinical characteristics and the change of strategy of circulation resuscitation after hemodynamic monitoring in the two gourps’ patients were analyzed.Results In this study,96 patients with shock were enrolled, and 47 patients received basic hemodynamic monitoring (basic group),49 patients received advanced hemodynamic monitoring (advanced group). The number of WBC, APACHE Ⅱ and SOFA score were increased in the advanced group than that of basic group, although there wasn’t significantly difference between the two groups. For others parameters, including patients’ age, gender, shock type and results of laboratory test, there existed no difference in the two groups. For the volume management, before and after hemodynamic monitoring, in the primary group,61.7.3%(57.4%)patients were treated with intravascular fluid loading, 23.4%(21.3%)patients treated with fluid balance and 14.9%(21.3%) patients were treated with negative fluid balance, in the Senior group,69.4%(51%) patients were treated with intravascular fluid loading,30.6%(32.7%) patients treated with fluid balance and 0%(16.3%) patients were treated with negative fluid balance, After hemodynamic monitoring, the strategy of fluid resuscitation was changed in the two groups, but the change was greater in the limitation of fluid in the advanced group than that of basic group (p<0.05). For the vasoactive drugs, before and after hemodynamic monitoring, in the primary group,74.5%(66%) patients were treated with contraction vasoactive drugs, and 25.5%(34%) of the patients who had discontinued the vasoactive drugs, in the Senior group,69.4%(73.5%) patients were treated with contraction vasoactive drugs, and 30.6% (26.5%) of the patients who had discontinued the vasoactive drugs, there was no significant change in the two groups following the sitting of hemodynamic monitoring. For the inotropic drugs, before and after hemodynamic monitoring, in the primary group,0% (6.4%) patients were treated with inotropic drugs,In the Senior group,0%(24.5%) patients were treated with inotropic drugs,However, the employment of inotropic drugs was increased in the two groups after hemodynamic monitoring, but these drugs were used more frequently in the advanced group than that of basic group (p<0.05).Conclusion (1) The functional hemodynamic parameters, such as SVV, could provide the further information about cardiac preload, in order to facilitate fluid management for the patients suffering from shock. (2) The methods, which measuring the cardiac output directly or indirectly, could indicate on time the state of heart function in the patients with shock, in that the inotropic drugs could be added to help correct the circulation failure.