Study Of Fluid Resuscitation For Cardiac Dysfunction With Septic Shock

Objective:The aim of this study was to explore the difference between the global end-diastolic volume index(GEDI)-directed fluid resuscitation and central venous pressure(CVP)in cardiac dysfunction with septic shock.The group was superior in the total amount of resuscitation fluid,extravascular lung water index(EVLWI),vasoactive drug dosage,lactate clearance,liquid negative balance start time,mechanical ventilation time,ICU mortality,28d mortality,etc.In the CVP group,a scientific basis was provided for the fluid resuscitation of cardiac dysfunction and septic shock.Method:A total of 41 cardiac dysfunction patients with septic shock were randomly divided into 2 groups:the CVP group(n=21)or the GEDI group(n=20).Patients in CVP group were treated with standard early goal-directed therapy(EGDT),making CVP 8-12 mmHg and mean arterial pressure?65 mmHg and urinary volume?0.5ml/kg/h and central venous oxygen saturation?70%.Other subjects were directed by GEDI,which were acquired by pulse-indicated continuous cardiac output,and GEDI should reach 680-800ml/m~2 when fluid resuscitation was completed.Goals of treatment in GEDI group,included mean arterial pressure(MAP)?central venous oxygen saturation(ScvO2)and urine volume,were equal to CVP group.The outcomes were recorded as listed:the fluid volume when achieved resuscitation goals,EVLWI and BNP in 6 hrs and in 24 hrs,blood lactate clearance rate,norepinephrine dosage,start time of liquid negative balance,duration of mechanical ventilation,mortality in ICU and 28-day mortality.Result:All of EVLWI and BNP,and liquid volume when achieved the resuscitation target,in GEDI group were less than the CVP Group significantly(P<0.05).However,there was no significant difference in EVLWI between the two groups at 6 hours.{6h EVLWI:[8.4,(5.8,9.4)]ml/kg ratio[9.5,(8.0,9.8)]ml/kg,(Mann-Whitney U=74.5,P=0.1482)}.The lactate clearance rate in GEDI group was better than that in CVP group,and NE dosage could be reduced more,liquid negative balance started earlier,and mechanical ventilation time was significantly shortened(P<0.05).GEDI-directed fluid resuscitation is beneficial to alleviate pulmonary edema and not aggravate cardiac function impairment significantly,but there were no difference in mortality of ICU[20.0%versus 38.1%,(x~2=1.620,P=0.2031)]and 28-day mortality[25.0%versus42.9%,(x~2=1.482,P=0.4766)].Conclusion:GEDI-directed fluid resuscitation for cardiac dysfunction patients with septic shock can achieve fluid resuscitation target effectively,with less vasoactive agent and fluid volume of resuscitation when achieved recovery target.GEDI-directed fluid resuscitation is beneficial to alleviate pulmonary edema and not aggravate cardiac function impairment significantly.The liquid negative balance can be performed earlier and duration of mechanical ventilation can be shortened in patients accepted GEDI-directed fluid resuscitation,but the ICU mortality and 28-day mortality cannot be improved.