Downloads
Abstract
Background: Septic shock has high mortality rate. The early collaborating of the Pulse Contour Cardiac Output (PiCCO) system to monitor and treat septic shock quickly achieving target blood pressure can consequently reduce organ failure and increase survival rate. This study aims to determine time to vasopressor discontinuation and the mortality rate when combining CRRT and early hemodynamic resuscitation under monitoring by the PiCCO system, and explore the risk factors for death.
Methods: A prospective, interventional study. PiCCO parameters were measured on 40 patients with septic shock at T0, T1, T3, T12, T24, T48.
Results: The mean time to vasopressor discontinuation was 27,8 ± 20,9 hours. The in-hospital mortality rate was 32,5% and the 30 - day mortality rate was 35%. Risk factors for death included cirrhosis (p = 0,04), diabetes mellitus (p = 0,03), lactate at T0 ≥ 4 mmol/L (p = 0,03), multiple organ dysfunction ≥ 3 (p = 0,03), APACHE II score at T48 ≥ 23 (p = 0,02), mechanical ventilation (p < 0,01), CI at T0 < 3 L/min/m² (p = 0,01), SVRI at T0 < 1200 DS/cm5/m² (p < 0,01), PVPI at T12 ≥ 3 (p = 0,04), and EVLWI at T0, T1, T3, T12, T24 ≥ 10 mL/kg (p < 0,05).
Conclusion: Time to vasopressor discontinuation was shorted, and mortality rate was reduced when resuscitating early with PiCCO system monitoring in patients with septic shock. Parameters on the PiCCO system help predict the risk of death
References
Bình NG, Tuấn ĐQ, Cường ĐT, Anh TD, Huy ĐQ, Cơ ĐX và cs. Nghiên cứu ứng dụng các kỹ thuật lọc máu hiện đại trong hồi sức cấp cứu bệnh nhân nặng và ứng phó với một số dịch bệnh nguy hiểm, in Đề tài cấp nhà nước. Bệnh viện Bạch Mai. 2011: 52-81.
Kỷ LN. Đánh giá hiệu quả của kỹ thuật lọc máu liên tục trong điều trị suy đa tạng, in Bệnh viện đa khoa Tỉnh Khánh Hòa. 2017:52-81.
Evans L, Rhodes A, Alhazzani W, Antonelli M, Coopersmith CM, French C, et al., Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021. Intensive Care Med. 2021;47(11):1181-1247.
Singer M, Deutschman CS, Seymour CW, Shankar-Hari M, Annane D, Bauer M, et al. The third international consensus definitions for sepsis and septic shock (Sepsis-3). JAMA. 2016;315(8):801-10.
Quân NH, Nghiên cứu hiệu quả huyết động với sự hỗ trợ của phương pháp PiCCO trong xử trí sốc nhiễm khuẩn. Trường đại học Y Hà Nội. 2016:90 - 130.
Tiển TD. Ứng dụng kỹ thuật theo dõi cung lượng tim PiCCO trong điều trị sốc nhiễm khuẩn. Tạp chí Y học Thành phố Hồ Chí Minh. 2022;26(2):73.
Costantini E, Carlin M, Porta M, Brizzi MF. Type 2 diabetes mellitus and sepsis: state of the art, certainties and missing evidence. Acta Diabetologica. 2021;58(9):1139-1151.
Berbudi A, Rahmadika N, Tjahjadi AI, Ruslami R. Type 2 diabetes and its impact on the immune system. Curr Diabetes Rev. 2020;16(5):442-449.
Tuyết LTD, Tuấn TM. Đánh giá tác dụng của lọc máu liên tục trong điều trị suy đa tạng tại khoa điều trị tích cực bệnh viện Bạch Mai. Y học thực hành. 2009;668(7):84-87.
Le Gall JR, Lemeshow S, Saulnier F. A new simplified acute physiology score (SAPS II) based on a European/North American multicenter study. JAMA. 1993;270(24):2957-63.
Liu N, Ren J, Yu L, Xie JJJoE, Medicine CC, Mechanical ventilation associated with worse survival in septic patients: a retrospective analysis of MIMIC-III. Journal of Emergency and Critical Care Medicine. 2020;4:1-8.
Lokhandwala S, Andersen LW, Nair S, Patel P, Cocchi MN, Donnino MW, Absolute lactate value vs relative reduction as a predictor of mortality in severe sepsis and septic shock. J Crit Care. 2017;37:179-184.
Lee EP, Chu SC, Hsia SH, Chen KF, Chan OW, Lin CY, et al., Comparison of predictive powers for mortality between systemic vascular resistance index and serum lactate in children with persistent catecholamine-resistant shock. Biomed Res Int. 2020;2020:1341326.
Kushimoto S, Taira Y, Kitazawa Y, Okuchi K, Sakamoto T, Ishikura H, et al. The clinical usefulness of extravascular lung water and pulmonary vascular permeability index to diagnose and characterize pulmonary edema: a prospective multicenter study on the quantitative differential diagnostic definition for acute lung injury/acute respiratory distress syndrome. Critical care (London, England). 2012;16(6):1-15.
| Published | 28-12-2024 | |
| Fulltext |
|
|
| Language |
|
|
| Issue | No. 94 (2024) | |
| Section | Original article | |
| DOI | 10.38103/jcmhch.94.1 | |
| Keywords | PiCCO, Sốc nhiễm khuẩn PiCCO, Septic shock |
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
Copyright (c) 2024 Journal of Clinical Medicine Hue Central Hospital