GEDI vs. CVP-directed fluid resuscitation for septic shock in COPD patients: a randomized controlled trial

doi:10.3877/cma.j.jssn.2096-1537.2016.03.012

Abstract

Abstract:

Objective

To evaluate the clinical efficiencies of GEDI (global end-diastolic volume index) -directed fluid resuscitation in chronic obstructive pulmonary disease (COPD) patients with septic shock.

Methods

A total of 71 cases with COPD associated with septic shock were enrolled from the Intensive Care Unit of the Northern Jiangsu People′s Hospital from January, 2012 to April, 2014 and randomly assigned to 2 groups for controlled study. In the control group (n=37), fluid resuscitation was performed according to the measurements of central venous pressure (CVP). In the study group (n=34), fluid resuscitation was performed until GEDI reached 800 ml/m2. The following indices were recorded in 2 groups: fluid volume resuscitated in 6 hrs and in 24 hrs, norepinephrine dosage, blood lactate clearance rate in 24 hrs, 72-hour acute physiology and chronic health evaluation (APACHE II) score and sequential organ failure assessment (SOFA) score, duration of mechanical ventilation, length of stay in ICU (intensive care unit), ICU mortality, and 90 d survival rate.

Results

Whether in 6 hrs or in 24 hrs, the fluid volume resuscitated was lower and NE dosage was higher in the control group than in the study group (P<0.05). After 24 h of treatment, the blood lactate was (4.79±1.95) mmol/L in the control group and (3.44±1.45) mmol/L in the study group (t=2.59, P<0.05); mean 24-hour blood lactate clearance rate was 19.79%±8.95% in the control group and 48.74%±9.2% in the study group (t=4.29, P<0.05); 72-hour APACHE II score and SOFA score were higher in the control group than in the study group (P<0.05). Mean duration of mechanical ventilation was (101.22±44.77) h in the control group and (74.71±20.25) h in the study group (t=2.234, P<0.05); Mean length of stay in ICU was (11.3±2.1) d in the control group and (7.4±1.9) d in the study group (P<0.05). During the treatment in ICU, 10 (27.0%) in the control group and 7 (20.6%) in the study group died, and there was no significant difference between 2 groups regarding the mortality rate (χ2=0.03, P>0.05). In addition, 90-day survival rate was not significantly different between 2 groups (χ2=1.083, P>0.05).

Conclusion

Most patients with long-term COPD are associated with right ventricular dysfunction, therefore CVP is difficult to reflect the real blood volume. GEDI-directed fluid resuscitation shows better clinical results than CVP-directed fluid resuscitation in COPD patients with septic shock without reducing mortality rate.

Key words: Chronic obstructive pulmonary disease, Infection, Shock

Jiangquan Yu, Ruiqiang Zheng, Hua Lin, Qihong Chen, Jun Shao. GEDI vs. CVP-directed fluid resuscitation for septic shock in COPD patients: a randomized controlled trial[J]. Chinese Journal of Critical Care & Intensive Care Medicine(Electronic Edition), 2016, 02(03): 193-198.

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References 25

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组别	例数	年龄（岁）	APACHE Ⅱ评分	SOFA评分	入ICU时MAP（mmHg）	入ICU时CVP（mmHg）	入ICU时乳酸（mmol/l）	性别（例）		感染来源（例）			其他（例）
组别	例数	年龄（岁）	APACHE Ⅱ评分	SOFA评分	入ICU时MAP（mmHg）	入ICU时CVP（mmHg）	入ICU时乳酸（mmol/l）	男	女	肺	腹腔	皮肤软组织	其他（例）
对照组	37	71±5.7	20.1±4.0	18.0±3.2	47.8±7.6	6.9±2.9	6.3±2.1	21	16	27	4	2	4
研究组	34	70±6.5	19.9±5.1	17.7±4.6	48.1±7.4	7.2±2.8	6.9±3.4	20	14	25	4	1	4
t值	0.58	0.75	0.50	0.63	1.05	0.98	0.14	0.21	0.00	0.32	1.28	0.32
P值	0.372	0.218	0.390	0.321	0.163	0.187	0.542	0.466	0.72	0.402	0.133	0.406

组别	例数	年龄（岁）	APACHE Ⅱ评分	SOFA评分	入ICU时MAP（mmHg）	入ICU时CVP（mmHg）	入ICU时乳酸（mmol/l）	性别（例）		感染来源（例）			其他（例）
组别	例数	年龄（岁）	APACHE Ⅱ评分	SOFA评分	入ICU时MAP（mmHg）	入ICU时CVP（mmHg）	入ICU时乳酸（mmol/l）	男	女	肺	腹腔	皮肤软组织	其他（例）
对照组	37	71±5.7	20.1±4.0	18.0±3.2	47.8±7.6	6.9±2.9	6.3±2.1	21	16	27	4	2	4
研究组	34	70±6.5	19.9±5.1	17.7±4.6	48.1±7.4	7.2±2.8	6.9±3.4	20	14	25	4	1	4
t值	0.58	0.75	0.50	0.63	1.05	0.98	0.14	0.21	0.00	0.32	1.28	0.32
P值	0.372	0.218	0.390	0.321	0.163	0.187	0.542	0.466	0.72	0.402	0.133	0.406

组别	例数	6 h液体复苏量（ml）	24 h液体复苏量（ml）	6 h去甲肾上腺素用量［μg/（min?kg）］	24 h去甲肾上腺素用量［μg/（min?kg）］	血乳酸（mmol/l）	24 h血乳酸清除率（%）
对照组	37	1224.2±198.1	4761.4±328.5	0.56±0.17	0.43±0.19	4.79±1.95	19.79±8.95
研究组	34	1824.9±241.1ml	6327.3±265.9ml	0.29±0.07	0.18±0.06	3.44±1.45	48.74±9.2
t/χ²值		-4.35	-5.71	2.45	4.99	2.59	4.29
P值		0.000	0.000	0.023	0.000	0.013	0.003
组别	例数	72 h APACHE Ⅱ评分	72 h SOFA Ⅱ评分	机械通气时间（h）	ICU住院时间（d）	病死率（%）
对照组	37	18.7±6.1	14.2±3.9	101.22±44.77	11.3±2.1	27.0（10/37）
研究组	34	12.6±4.3	8.6±2.2	74.71±20.25	7.4±1.9	20.6（7/34）
t/χ²值		1.91	2.28	2.23	-3.83	1.08
P值		0.047	0.031	0.032	0.003	0.298

组别	例数	6 h液体复苏量（ml）	24 h液体复苏量（ml）	6 h去甲肾上腺素用量［μg/（min?kg）］	24 h去甲肾上腺素用量［μg/（min?kg）］	血乳酸（mmol/l）	24 h血乳酸清除率（%）
对照组	37	1224.2±198.1	4761.4±328.5	0.56±0.17	0.43±0.19	4.79±1.95	19.79±8.95
研究组	34	1824.9±241.1ml	6327.3±265.9ml	0.29±0.07	0.18±0.06	3.44±1.45	48.74±9.2
t/χ²值		-4.35	-5.71	2.45	4.99	2.59	4.29
P值		0.000	0.000	0.023	0.000	0.013	0.003
组别	例数	72 h APACHE Ⅱ评分	72 h SOFA Ⅱ评分	机械通气时间（h）	ICU住院时间（d）	病死率（%）
对照组	37	18.7±6.1	14.2±3.9	101.22±44.77	11.3±2.1	27.0（10/37）
研究组	34	12.6±4.3	8.6±2.2	74.71±20.25	7.4±1.9	20.6（7/34）
t/χ²值		1.91	2.28	2.23	-3.83	1.08
P值		0.047	0.031	0.032	0.003	0.298

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