Application of extravascular lung water combined with central venous-arterial carbon dioxide difference in early goal-directed therapy for septic shock

Abstract:

Objective：To investigate the value of dynamic monitoring of extravascular lung water（EVLW） combined with central venous-arterial difference of CO2 partial pressure（P（cv-a）CO2） in early goal-directed therapy（EGDT） for septic shock. Methods：Eighty patients with septic shock，who were admitted to the Intensive Care Unit of the Second Affiliated Hospital of Chongqing Medical Uni－versity and Chongqing Hospital of Traditional Chinese Medicine from 2015 to 2018，were enrolled and randomly divided into EGDT group and EVLW+ P（cv-a）CO2（EP） group. The patients in the EGDT group underwent conventional fluid resuscitation，and those in the EP group underwent fluid resuscitation under monitoring with pulse-induced contour cardiac output. The two groups were compared in terms of the rate of achieving EGDT target after 6-h resuscitation，resuscitation fluid volume，the dose of noradrenaline，urine volume/kg body weight/hour，lactic acid clearance rate，P（cv-a）CO2，EVLW，and 28-day mortality. Results：Compared with the EGDT group，the EP group had significantly higher urine volume/kg body weight/hour and lactic acid clearance rate（P<0.05） and significantly lower 6-h resuscitation fluid volume，central venous pressure，dose of vasoactive agent，P（cv-a）CO2，EVLW，and 28-day mortality（P<0.05）. There were no significant differences in the rate of achieving EGDT target after 6-h resuscitation，mean arterial pressure，and central venous oxygen saturation between the two groups（P>0.05）. Conclusion：In EGDT for septic shock，EVLW combined with P（cv-a）CO2 can help assess the tissue perfusion and volume loading of pa－tients early and accurately，thus guiding fluid resuscitation and reducing the mortality of patients.