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Objective:To explore the effect of large-volume versus restrictive fluid resuscitation on hemodynamics and prognosis in patients with severe acute pancreatitis (SAP). Methods:A total of 102 patients with severe acute pancreatitis who received treatment in The Second People's Hospital of Hefei, China between March 2018 and December 2020 were included in this study. They were randomly assigned to undergo large-volume fluid resuscitation (control group, n = 51) or restrictive-volume fluid resuscitation (study group, n = 51). Hemodynamic indexes, intra-abdominal pressure and pulmonary function were compared between the two groups before and after resuscitation. All patients were followed up for 28 days after admission and their prognosis was recorded. Results:At 12 and 24 hours of resuscitation, intrathoracic blood volume index, global end-diastolic volume index, cardiac index, and central venous pressure in the study group were significantly higher than those in the control group (all P < 0.05). At 6 hours of resuscitation, cardiac index and central venous pressure in the study group were (4.87 ± 0.48) and (11.04 ± 2.08), respectively, which were significantly higher than those in the control group [(4.53 ± 0.57), (9.48 ± 1.67), t = 3.25, 4.17, both P < 0.05). Before resuscitation, there was no significant difference in intra-abdominal pressure between the two groups ( P > 0.05). After resuscitation, intra-abdominal pressure in each group was significantly lower compared with that before resuscitation (both P < 0.05). After resuscitation, intra-abdominal pressure in the study group was significantly lower than that in the control group [(12.78 ± 2.35) cmH 2O vs. (15.01 ± 2.42) cmH 2O, t = 4.72, P < 0.05). Before resuscitation, there were no significant differences in PaO 2 and oxygenation index between two groups (both P < 0.05). After resuscitation, PaO 2 and oxygenation index in each group were significantly higher compared with those before resuscitation (both P < 0.05). After resuscitation, PaO 2 and oxygenation index in the study group were significantly higher than those in the control group ( t = 3.02, 5.55, both P < 0.05). The incidence of abdominal compartment syndrome and the incidence of invasive mechanical ventilation in the study group were 27.45% (14/51) and 35.29% (18/51), respectively, which were significantly lower than those in the control group [47.06% (24/51), 56.86% (29/51), χ 2 = 4.19, 4.77, both P < 0.05). There were no significant differences in the incidence of multiple organ dysfunction syndrome, acute renal injury, abdominal drainage rate, mortality between the two groups (all P > 0.05). Conclusion:Compared with large-volume fluid resuscitation, restrictive-volume fluid resuscitation can better improve hemodynamic indexes and pulmonary function, greatly decrease intra-abdominal pressure, and improve prognosis in patients with severe acute pancreatitis.
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Objective To examine the effect of rapid infusion test guided by extravascular lung water index (EVLWI) on hemodynamics in critically ill patients at different states in order to guide volume resuscitation.Methods A prospective observation was conducted.Forty critically ill patients admitted to Department of Critical Care Medicine of Tianjin Third Central Hospital from June 2012 to April 2014 were enrolled.Based on the levels of EVLWI and pulmonary vascular permeability index (PVPI) and the cardiac function,the patients were divided into four groups:septic patients with normal EVLWI and PVPI (n =17),septic patients with increased EVLWI and PVPI (n =3),septic patients with increased EVLWI and normal PVPI (n =4),and coronary heart disease and heart failure patients with normal EVLWI and PVPI (n =16).The rapid infusion test was conducted in all patients using lactated Ringer solution 250 mL,followed by infusion of crystalloid with rate of 150 mL/h.The conditions of mechanical ventilation and vasoactive drugs were not changed during study.The changes in EVLWI,intrathoracic blood volume index (ITBVI),and cardiac index (CI) before capacity load,at immediate capacity load,and 15,45,105 minutes after load were determined by pulse indicator continuous cardiac output (PiCCO).On the base of volume status before and after the liquid infusion,the standard for the changes were:stroke volume (SV) increased by 12％-15％,central venous pressure (CVP) greater ≥ 2 mmHg (1 mmHg =0.133 kPa),CI ＞ 15％,and ITBVI change greater than 10％.Results There were no statistically significant differences in the observed indicators at the each time point before and after rapid infusion test among the four groups (all P ＞ 0.05).In septic patients with normal EVLWI and PVPI group,ITBVI was slightly increased by 5.4％-9.7％ from 15 minutes to 45 minutes after rapid infusion test.In coronary heart disease and heart failure patients with normal EVLWI and PVPI group,the EVLWI was increased by 11.9％,5.9％,and 14.7％ respectirely at 15,45,and 105 minutes,ITBVI was slightly increased by 6.4％ at 45 minutes,CI was increased by 29.5％ immediately after rapid infusion.In septic patients with increased EVLWI and PVPI group,CVP was increased by 8 mmHg immediately,EVLWI was increased significantly by 15.8％ at 45 minutes,ITBVI was slightly decreased by 10.0％ at 45 minutes,CI was increased by 24.7％ immediately,and increased by 17.0％ at 105 minutes,and PVPI was increased by 15.6％-28.1％ at 15-105 minutes after rapid infusion.In septic patients with increased EVLWI and normal PVPI group,CVP was increased by 1.5 mmHg at 15 minutes,EVLWI was increased immediately,which was increased by 17.4％,24.0％,and 31.4％ respectively at 15,45,and 105 minutes,ITBVI was increased by 13.9％ at 15 minutes,CI was increased by 16.1％ at 15 minutes after rapid fluid infusion.Conclusions Rapid fluid replacement in critically ill patients with crystalloid,regardless of whether the EVLWI was normal or increased,the short-term response was affected by the volume and cardiac function of patients.Different status of patients showed different volume effect curve:no significant changes in hemodynamic parameters were found in patients with normal EVLWI and volume parameters.In patients with potential cardiac dysfunction,CI and EVLWI increased significantly; regardless of PVPI increased or normal,EVLWI and CI were increased in patients with elevated EVLWI; two different changes could be found in the two types of pulmonary edema while ITBVI was increased.
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Objective To analyze the influence of vasoactive drugs on hemodynamics in septic shock patients and to explore the guiding value of systemic vascular resistance index (SVRI) for the application of vasoactive drugs .Methods 21 cases of septic shock in ICU from March 2010 to April 2012 were retrospectively analyzed .The PiCCO monitor technique was applied to monitor the he-modynamic parameters including the cardiac index (CI) ,intrathoracic blood volume index (ITBI) ,systemic cenous resistance index (SVRI) and mean arterial pressure(MAP) ,once per 6-8 h .ITBI>850 mL/m2 was taken as the normal criterion .The data of 202 cases meeting the criterion were collected .These cases were divided into two groups according to whether MAP reach 65 mm Hg , the differences of hemodynamic parameters between the two groups were compared .The MAP≥65 mm Hg group was redivided in-to the group 1 ,2 and 3 according to SVRI .Blood characteristics of pressure ,CI and ITBI were compared among these 3 groups .Re-sults The ITBI value in the MAP<65 mm Hg group and the MAP≥65 mm Hg group was higher than the normal value .The CI and SVRI values in the MAP≥65 mm Hg group were higher than those in the MAP< 65 mm Hg group(P<0 .05) ,while the ITBI value had no difference between the two groups .The ITBI values in the three groups with different SVRI all were higher than the upper normal limit ,furthermore ,in the comparisons among 3 groups ,only comparison between the group 1 and the group 3 had sta-tistical difference(P= 0 .47) .When SVRI was lower ,the CI value was higher than the normal value .Along with the increase of SVRI ,MAP increased gradually ,and CI gradually declined .When SVRI was too high ,MAP had no significant increase ,but the CI value was lower than the lower limit .Conclusion The SVRI monitoring by PiCCO can help to guide the application of vasoactive drugs in septic shock patients ,lower SVRI means the declined vascular reaction and higher SVRI indicates the low cardiac function , moreover blood pressure can not be further enhanced by vascular excessive contraction .