Effect Of PiCCO-guided CRRT Fluid Management On The Prognosis Of Critically Ill Patients

Objective To retrospectively analyze the guiding function of pulse indicator continuous cardiac output(Pi CCO)in continuous renal replacement therapy(CRRT)and the effect on the prognosis of critically ill patients.Methods All case data were collected from 85 critically ill patients who were treated with CRRT in the emergency intensive care unit(EICU)of The First Affiliated Hospital of Anhui Medical University from May 2015 to February 2018.Among them,40 patients receiving monitoring of Pi CCO through central venous catheters and arterial catheters were included in Pi CCO group,we can monitor the changes of intrathoracic blood volume index(ITBVI)?systemic vascular hold index(SVRI)and extravascular lung water index(EVLWI)change,The changes of mean arterial pressure(MAP)?ITBVI and EVLWI were used to guide the liquid management of CRRT.Other 45 patients receiving monitoring of central venous pressure(CVP)through central venous catheters were included in the CVP group,They Guide the liquid management of CRRT according to the changes of CVP and MAP.Changes of hemodynamic parameters of patients in Pi CCO group before and after treatment with CRRT at 12 h,24h and 72 h were recorded.Changes in total 3days fluid intake and ICU stay time in Pi CCO group and CVP group were recorded.To observe whether the incidence of hypotension,lactic acid elevation rate and 28-day mortality rate were different between the two groups.Results(1)Changes of hemodynamic parameters in Pi CCO group: compared with before treatment,ITBVI and SVRI began to rise and EVLWI began to decline 12 h after CRRT treatment,and the differences were statistically significant.After 24 h and 72 h,ITBVI,SVRI and EVLWI gradually tended to be stable.There was no statistically significant difference in CVP before and after treatment;(2)Comparison of APACHE II score between Pi CCO group and CVP group: compared with CVP group,there was no statistically significant difference in APACHE II score between Pi CCO group before CRRT treatment(P > 0.05).APACHE II scores in the Pi CCO group were significantly lower than those in the CVP group at 12 h,24h and 72 h after treatment,with statistically significant differences(P < 0.05).In Pi CCO group,the 3-day total fluid intake was(10.93±2.01)L,less than CVP group(15.12±3.07)L,and the ICU stay time in Pi CCO group was(13.43±2.84)d less than CVP group(15.17±2.91)d,the difference was statistically significant(P < 0.05);(4)The incidence rates of volume-related hypotension,pulmonary edema,Lac greater than 2 mol/l and 28-day mortality rate in Pi CCO group(7.50%,5.00%,10.00%,10.00%)were significantly lower than those in the CVP group(24.44%,20.00%,28.89%,28.89%)(P<0.05).the difference was statistically significant(P < 0.05).Conclusion Compared with CVP,Pi CCO guided CRRT can effectively improve the effects of fluid resuscitation,reduce complications and improve the prognosis of critically ill patients.