Clinical study on the value of early hemodynamic intervention in the management of hypovolemic shock with unknown cause

Abstract:

Objective：To investigate the ‘early hemodynamic intervention’ in the management of hypovolemic shock with unknown cause for providing scientific basis for early treatment. Methods：A total of 56 patients with hypovolemic shock admitted to the De－partment of Critical Care Medicine of The People’s Hospital of Dazu District from September 2013 to January 2017 were enrolled and randomly divided into the experimental group and the control group，with 28 patients in each. In the experimental group，2 patients asked to go to the superior hospital for treatment，and 1 gave up the treatment，while in the control group，2 gave up the treat－ment and 3 were transferred to the superior hospital for treat－ment. Therefore，25 patients in the experimental group and 23 in the control group were finally included in the analysis. The ex－perimental group underwent the early target-directed liquid ther－apy（EGDT） and the fluid resuscitation was guided by central venous pressure（CVP），while the control group adopted the traditional method of volume resuscitation. Both groups were properly de－hydrated to reduce the pre-cardiac load in order to protect the cardiopulmonary function. The scores on acute physiology and chronic health evaluation system Ⅱ（APACHE Ⅱ） before and after treatment，mean arterial pressure（MAP），CVP，lactate clearance rate，the quantity of liquid，and the numbers of patients using vasoactive drugs，with renal damage，pulmonary edema or congestive heart failure were recorded respectively. Meanwhile，the case numbers of patients with repeated insufficient blood volume undergoing re-added blood volume within 72 hours and patients whose standard rate of compliance was corrected at 3 h and 6 h after treatment were also recorded，as well as the ICU admission days and death numbers of both groups. Results：APACHEⅡ scores decreased gradually in both groups，and scores in the experimental group were significantly lower than those in the control group after 24 hours（P<0.05）. Seventy-two hours after treatment，patients on vasoactive drugs，with renal dysfunction or re-shock in the experimental group were fewer than those of the control group respectively（P<0.05），while the patients with pulmonary edema or congestive heart failure in the experimental group were more than those of the control group respectively（P<0.05）. The amount of recovery liquid within 6 h and 24 h of the experimental group was obviously more than that of the control group，while it in 72 h was less than that of the control group（P<0.05）. The lactate clearance rates of the experimental group at 6 h and 24 h after treatment were both superior to those of the control group（P<0.05）. The CVP and MAP in both groups were significantly improved after treatment，and CVP of the experimental group at 6 h，24 h and 72 h after treatment were superior to those of the control group（P<0.05），and MAP of the experimental group at 6 h and 24 h after treatment were superior to those of the control group（P<0.05）. The numbers of cases whose standard rate of com－pliance was corrected at 3 h and 6 h after treatment in the experimental group were higher than those of the control group（P<0.05）. There was no significant difference of the ICU admission days and death numbers between the two groups（P>0.05）. Conclusion：The ‘early hemodynamic intervention’ with EGDT liquid therapy for hypovolemic shock with unknown cause is of significant effect，but still not sufficient in the recovery process due to the fluid overload heart failure and the high incidence of pulmonary edema iatrogenic injury. Therefore，a hypothesis of searching the best pre-cardiac load in the capacity treatment phase is proposed.