Clinical study of critical ultrasound and pulse-indicated continuous cardiac output monitoring to guide capaciyu management of acute heart failure

Abstract:

Objective：To explore the capacity management of critical ultrasound and pulse-indicated continuous cardiac output（PiCCO） in patients with acute heart failure（AHF） and to compare the early therapeutic effect of those two methods，so as to provide a scientific basis for timely treating patients. Methods：AHF patients who met the admission criteria were selected from January 2017 to September 2018 in the intensive care unit（ICU） of Dazu District People’s Hospital and were randomly divided into the experimental group（n=30） and the control group（n=28）. The experimental group was guided by critical ultrasound monitor－ing，while the control group was guided by PiCCO monitoring. The N-terminal pro-brain natriuretic peptide（NT-proBNP），central venous pressure（CVP），mean arterial pressure（MAP），lac－tate clearance rate and central venous oxygen saturation（ScvO2） within 72 hours were compared among patients in two groups. The in－cidence of pulmonary infection，mechanical ventilation time，ICU occupancy time，28-day mortality rate，survival curve，6-hour re－covery and the number of cases that can be monitored within 3 hours were statistically recorded. Pre-and-post-treatment cardiac function and blood volume indexes of the two monitoring methods were compared. Results：NT-proBNP，CVP，MAP，lactate clearance and ScvO2 at the 72nd hour in two groups had no statistically significant difference（P>0.025）. The incidence of pulmonary infection in the experimental group was higher than that in the control group，with statistically significant difference（P<0.025）. The number of cases of capacity management that could be monitored within 3 hours in the experimental group was significantly higher than that in the control group，with statistically significant difference（P<0.05）. The number of cases of capacity management that could be moni－tored within 6 hours in two groups had no statistically significant difference（P>0.05）. Mechanical ventilation time，ICU stay time，28-day mortality and survival time in two groups had no statistically significant difference（P>0.05）. Comparison of cardiac function indexes before and after treatment：in the experimental group，the indexes of CO and LVEF before treatment were lower than those after treatment，with statistically significant difference（P<0.05）；in the control group，the indexes of CI and GEF before treatment were lower than that after treatment，with statistically significant difference（P<0.05）. Comparison of blood volume indexes before and after treatment：in the experimental group，the respiratory rate of inferior vena cava，LVEDV and SV after treatment were higher than those before treatment，and IVC after treatment was lower than that before treatment，with statistically significant difference（P<0.05）；in the control group，SVI after treatment was higher than that before treatment，and GEDI after treatment was lower than that before treatment，with statistically significant difference（P<0.05）. Conclusion：According to the clinical study of capacity management on critical ultrasound and PiCCO in patients with AHF，we find that both methods can accurately assess capacity and predict volume responsiveness. However，compared with PiCCO，critical ultrasound can significantly shorten the delay time in the course of treatment，can also be operated and monitored in time under the condition of hemodynamic changes，and belongs to non-invasive operation which can be repeatedly checked in the treatment. Real-time capacity management can reduce certain operational and therapeutic risks，such as the catheter-related infection and pulmonary infection，improving the early treatment ability for AHF patients. The short－comings of PiCCO and critical ultrasound can’t reduce the mortality，so it is necessary to further study other comprehensive treatment schemes to reduce the risk of death and improve the survival rate of patients with AHF.