Clinical study on the effects of global end-diastolic volume index-directed fluid resuscitation on the prognosis of chronic heart failure patients with septic shock
10.3760/cma.j.issn.0253-3758.2019.09.014
- VernacularTitle: 全心舒张末期容积指数指导下的液体复苏对慢性心力衰竭合并脓毒性休克患者预后的影响
- Author:
Leqing LIN
1
;
Dongcheng LIANG
;
Guangyong JIN
;
Baiyong WANG
;
Zhuxian ZHANG
;
Ning ZHANG
;
Xin LYU
;
Lei WANG
Author Information
1. Department of Intensive Care Unit, Affiliated Hospital of Hangzhou Normal University, Hangzhou 310015, China
- Publication Type:Clinical Trail
- Keywords:
Heart failure;
Shock, septic;
Global end-diastolic volume index;
Fluid resuscitation
- From:
Chinese Journal of Cardiology
2019;47(9):726-730
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To investigate the effect of global end-diastolic volume index (GEDI)-guided fluid resuscitation on the prognosis of patients with chronic heart failure and septic shock.
Methods:This study was a prospective randomized controlled study. Consecutive eligible patients were divided into 2 groups according to the random number table method: control group (n=21) and experimental group (n=20). On the basis of routine treatment, patients in the control group received early goal-directed therapy until the central venous pressure (CVP) reaching 8-12 mmHg (1 mmHg=0.133 kPa), mean arterial pressure reaching over 65 mmHg, urine volume reaching over 0.5 ml·kg-1·h-1, and central venous oxygen saturation reaching more than 70%. On the basis of routine treatment, patients in the experimental group were monitored continuously on cardiac output with pulse indication and fluid resuscitation guided by volume index GEDI. The GEDI should be maintained on the range of 680-800 ml/m2. The remaining resuscitation goals were the same as control group. General clinical data of the two groups were collected at admission. Negative fluid balance onset time, duration of mechanical ventilation, ICU mortality and 28-day mortality were compared between the two groups. The outcomes were recorded as listed: start time of negative fluid balance, duration of mechanical ventilation, mortality in ICU and 28-day mortality.
Results:There was no significant difference in age, sex, weight, APACHE Ⅱ score, SOFA score and NYHA functional class score between the two groups (all P>0.05). The negative liquid balance onset time in the control group was 3.5 (2.5, 4.0) days, which was significantly longer than that in the experimental group (2.6 (2.0, 3.0) days,U=115.0, P=0.012). The duration of mechanical ventilation was 355 (118, 552) hours in the control group, which was significantly longer than that in the experimental group (132 (36.75, 233.3) hours, U=130, P=0.038). The ICU mortality was 38.1% (8/21) in the control group, tended to be higher than that in the experimental group (20.0%(4/20), χ2=1.620, P=0.203). The 28-day mortality was 42.9% (9/21) in the control group, similar as in the experimental group (25.0%(5/20), χ2=1.482,P=0.477).
Conclusion:Fluid resuscitation guided by volume index (GEDI) may improve the prognosis of patients with chronic heart failure complicated with septic shock.
