The application of PiCCO in the early fluid resuscitation in patients with severe acute pancreatitis and ARDS

YANG Zhen-yu; WANG Hong-liang

doi:10.3969/j.issn.1002-1949.2015.11.009

Abstract：Objective To investigate the application of pulse indicator continuous cardiac output (PiCCO) in the early fluid resuscitation in patients with severe acute pancreatitis ( SAP) and acute respiratory distress syndrome (ARDS).Methods Forty cases of patients with SAP and ARDS treated in ICU were collected and randomly divided into control group and treatment group from June 2014 to June 2015 .All patients were monitored the PiCCO by a PiCCO monitor , and the patients in treatment group were treated with the resuscitation under the guides of PiCCO monitoring , but the patients in control group were treated with normal traditional fluid resuscitation according to the arterial pressure (MAP) of resuscitation 24 h and the central venous pressure (CVP).We compared with two groups of patients with 6 h, 24 h resuscitation liquid volume , compliance rate , mechanical ventilation time, blood flow dynamics parameters , 30-day mortality and other results .Results The 6 h, 24 h total fluid resuscitation, MAP of resuscitation 24 h, CVP, urine output per hour, dedicated end -diastolic volume index (GEDVI), intrathoracic blood volume index (ITBVI), cardiac index (CI) in the treatment group were significantly higher than those in the control group (P<0.05).The amount of vasoactive drugs ( noradrenaline ) , extravascular lung water index ( EVLWI ) , peripheral vascular resistance (SVRI), serum lactate concentration (Lac) and other indicators in the treatment group were significantly lower than those in the control group (P <0.05).In the resuscitation of compliance, treatment group recovery efficiency within6 h was higher( P<0.05), but no significant difference in recovery efficiency within 24 h between two groups (P>0.05).30-day mortality in treatment group was significantly lower than that in control group (P<0.05).The oxygenation index (PaO2/FiO2) in treatment group was significantly higher than that in control group (P<0.05).The control group showed a high probability of mechanical ventilation , and the duration of mechanical ventilation in treatment group was significantly shorter than that in the control group (P<0.05).Conclusion PiCCO is a simple hemodynamic technology .Under the guidance of PiCCO technology , we can control fluid resuscitation for patients with SAP and ARDS and improve hemodynamics effectively .The fluid resuscitation guided by PiCCO monitoring effectively improves tissue perfusion and oxygen metabolism , reduces the usage of blood vessel active drugs , controls extravascular lung water , and reduces the duration of mechanical ventilation and mortality .