To investigate the application of pulse-indicated continuous cardiac output (PiCCO) guided fluid resuscitation in septic shock patients with cardiac insufficiency.

One hundred and fifty four septic shock patients with cardiac insufficiency in Department of Intensive Care Unit of Dongtai People's Hospital from June 2019 to December 2022 were randomly divided into research group (79 cases) and control group (75 cases). PiCCO guided fluid resuscitation in research group was compared the River's early goal-directed therapy (EGDT) guided fluid resuscitation in the control group. The total resuscitated fluid, lactic acid and lactate clearance at each time point, duration of mechanical ventilation, morality in ICU and mortality at 28 day were recorded and compared between two groups.

After resuscitation: (1) In terms of the total amount of resuscitation fluid, (2602±1086) ml in research group and (3296±919) ml in control group, there was significant difference between 2 groups (P＜0.05); (2) In terms of central venous pressure (CVP), there was no significant difference (P＞0.05) at initial time point, but much lower after 24 h in research group with significant difference (P＜0.05); (3) In terms of lactated and lactate clearance, lactate level at 6 hour was (4.44±1.67) mmol/L in research group and (5.03±1.74) mmol/L in control group, all 2 groups had decreased lactate levels compared with the initial levels, and lactate level at 6 and 24 hour were lower in research group, with significant differences (P＜0.05); Lactate clearance rate was significantly higher in research group than that in the control group at each time point, with significant differences (P＜0.05); (4) The mean arterial pressure (MAP) at different time points was increased compared with the initial MAP, but there was no statistically significant difference (P＞0.05). N terminal pro -brain natriuretic peptide (NT-proBNP) and cardiac troponin I (cTnI) at 6 hour were lower in research group than those in the control group with significant differences (P＜0.05). In terms of dose of vasoactive drugs, dose of norepinephrine was significantly reduced in research group, with significant differences(P＜0.05). In terms of prognosis, duration of mechanical ventilation was significantly lower in research group, with significant differences (P＜0.05), but there was no significant difference in motalities (P＞0.05).

PiCCO has important clinical value in guiding fluid resuscitation in septic shock patients with cardiac insufficiency, by reducing total amount of resuscitation fluid, decreasing lung water and cardiac preload, but still improving tissue perfusion.