Application of pulse-indicated continuous cardiac output monitoring combined with critical care ultrasound-oriented convulsive therapy in the management of fluid intake in shock patients / 中国基层医药

ABSTRACT

Objective:To investigate the application value of pulse-indicated continuous cardiac output (PICCO) monitoring combined with critical care ultrasound-oriented convulsive therapy in the management of fluid intake in shock patients.Methods:Eighty-two patients with shock who received treatment in Shaoxing People's Hospital, China between May 2017 and May 2020 were included in this study. They were randomly assigned to undergo either PICCO monitoring (control group, n = 41) or PICCO monitoring combined with critical care ultrasound-oriented convulsive therapy (study group, n = 41). Fluid intake management-related indexes [24-hour total fluid intake, central venous pressure, mean arterial pressure, oxygenation index and lactic acid] and treatment outcome-related indexes (mechanical ventilation time, intensive care unit length of stay, 24-hour remission rate, 28-day mortality rate, sequential organ failure assessment score) were compared between control and study groups. Results:24-hour total fluid intake and lactic acid level in the study group were (2 516.98 ± 254.78) mL and (0.60 ± 0.05) mmol/L, respectively, which were significantly lower than those in the control group [(2 920.02 ± 295.33) mL, (1.34 ± 0.15) mmol/L, t = 16.573, 3.837, P < 0.01, P = 0.041). Central venous pressure, mean arterial pressure and oxygenation index in the study group were (13.381 ± 1.41) mmHg, (82.34 ± 8.22) mmHg and (224.06 ± 23.21) mmHg, respectively, which were significantly higher than those in the control group [(8.53 ± 0.85) mmHg, (70.92 ± 7.18) mmHg, (192.30 ± 19.70) mmHg, t = 5.152, 6.754, -2.498, all P < 0.05]. Mechanical ventilation time and intensive care unit length of stay in the study group were (7.54 ± 0.72) days and (11.46 ± 1.11) days, respectively, which were significantly shorter than those in the control group [(11.72 ± 1.13) days, (18.29 ± 1.73) days, t = 4.727, 5.224, both P < 0.05). 24-hour remission rate in the study group was significantly higher than that in the control group [85.37% (35/41) vs. 63.41% (26/41), χ2 = 5.185, P < 0.05]. 28-day mortality rate in the study group was significantly lower than that in the control group [7.32% (3/41) vs. 29.27% (12/41), χ2 = 6.608, P < 0.05]. Sequential organ failure assessment score in the study group was significantly lower than that in the control group [(6.86 ± 0.63) points vs. (11.05 ± 0.91) points, t = 4.814, P < 0.05]. Conclusion:PICCO monitoring combined with critical care ultrasound-oriented convulsive therapy exhibits an obvious effect in the management of fluid intake in shock patients, which can greatly reduce total fluid intake and remarkably improve treatment outcome-related indexes.