Clinical observation of fluid management strategy guided by intrathoracic blood volume index and extravascular lung water index in patients with severe acute pancreatitis

Zhou Sen; Xing Bo; Wang Xiaozhi; Wang Rixing

doi:10.3760/cma.j.issn.1673-4777.2015.10.016

Abstract：Objective To investigate the effect of fluid management strategy guided by intrathoracic blood volume index and extravascular lung water index in patients with severe acute pancreatitis (SAP) using intrathoracic blood volume index (ITBVI) and extravascular lung water index (EVLWI).Methods Fifty-eight patients with SAP in intensive care unit (ICU) from December 2010 to February 2015 were randomly divided into observation group (31 cases) and control group (27 cases).Observation group received fluid management guided by ITBVI and EVLWI through pulse indicator continuous output (PiCCO) monitoring;control group received traditional fluid management guided by central venous pressure (CVP).The following data were analyzed between the two groups:fluid output and intake,fluid balance volume in different periods within 72 hours after admission to ICU,compliance rate of early goal directed therapy (EGDT) 6 and 24 h after admission to ICU,hemodynamic parameters at different time points (0,6,24,48,72 h) after admission to ICU,acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score,serum lactic acid,serum creatinine,vasopressor score 1-3 days after treatment,duration of vasopressor,mechanical ventilation ratio,duration of mechanical ventilation,ICU stay and 28-day mortality.Results The compliance rate of EGDT 6 hours after admission to ICU in observation group was significantly higher than that in control group[80.6％ (25/31) vs 51.9％ (14/27)] (x2 =5.431,P =0.026),but no significant difference was found 6 hours after admission to ICU [x2 =0.878,P =0.489].The fluid intake and fluid balance volume during 0-6 hours period were significantly greater in observation group than those in control group [(1 925±558) mlvs (1 359±386) ml,(1 497±356) mlvs (976±328) ml] (P＜0.05);the fluid output during 48-72 hours was significantly greater in observation group than that in control group [(2 578 ±439) ml vs (1 944 ± 729) ml] (P ＜ 0.05);the fluid balance volume was significantly lower in observation group than that in control group [(539 ± 246) ml vs (1 058 ± 519) ml] (P ＜ 0.05);the fluid output and intake,and the fluid balance of other periods showed no difference between both groups (P ＞ 0.05).The ITBVI and EVLWI at different time points in observation group showed no difference compared with those in control group;the CVP,mean arterial pressure and heart rate at different time points also showed no differences between both groups (P ＞ 0.05).The mean arterial pressure was significantly increased,and the heart rate was significantly reduced 48 and 72 h after admission to ICU compared with those before admission in observation group [(86 ± 13),(89 ± 15) mmHg vs (62 ± 18) mmHg,(106 ± 26),(102 ± 27) times/min vs (129 ± 24) times/min] and control group:[(85±14),(88±14) mmHg vs (65±17) mmHg,(107±27),(106±25) times/min vs (132±26) times/min] (P ＜ 0.05).The APACHE Ⅱ,serum lactic acid and vasopressor score in observation group were significantly lower than those in control group 3 days after treatment[(19 ± 5) scores vs (24 ± 7) scores,(3.1 ± 2.7) mmol/L vs (5.8 ± 3.5) mmol/L,(12 ± 6) scores vs (17 ± 8) scores] (P ＜ 0.05).The mechanical ventilation ratio,duration of mechanical ventilation,duration of vasopressor,ICU stay and 28-days morality in observation group were significantly lower than those in control group [29.0％ (9/31) vs 51.9％ (14/27),(6.9±3.0) d vs (8.5 ±2.6) d,(66 ±29) h vs (85 ±28) h,(8.5 ±3.4) d vs (10.4 ±2.8) d,16.1％(5/31) vs 40.7％ (11/37)] (P＜0.05).Conclusion Fluid management strategy guided by ITBVI and EVLWI can accurately assess and guide fluid management in SAP,with less duration of mechanical ventilation,ICU stay and mortality.