Hemodynamics of elderly patients with septic shock monitored by pulse indicator continuous cardiac output / 中华老年医学杂志

ABSTRACT

Objective To investigate the changes of cardiovascular hemodynamics in elderly patients with septic shock using pulse indicator continuous cardiac output (PiCCO).Methods Fifty elderly patients with septic shock at the General Hospital of Guangzhou Military Command were enrolled from January 2015 to December 2015.We collected clinical data,including gender,age,acute physiological and chronic health evaluation (APACHE Ⅱ) score,sequential organ failure assessment (SOFA) score,and the PiCCO parameters,such as cardiac index (CI),stroke volume index (SVI),systemic vascular resistance index (SVRI),cardiac function index (CFI),global ejection fraction (GEF),extravascular lung water volume index (EVLWI),etc.All clinical data were retrospectively analyzed.Results Compared with medical reference ranges,the majority of elderly patients with septic shock had low levels of CI (n=35),SVI (n=41),CFI (n =39) and GEF (n=46) and high levels of EVLWI (n =34).More patients over 75 years than those under 75 years showed lower CI (n=33,or 80.5％ vs.n =2,or 22.2％,x2 =13.511,P=0.001),lower CFI (n=35,or 85.4％ vs.n=4,or 44.4％,x-=7.236,P =0.027),and higher SVRI (n =24,or 58.5％ vs.n =0 or 0.0％,x2 =10.392,P=0.006).CI and CFI levels were negatively correlated with patient age (r=-0.460,P=0.001;r=-0.384,P=0.006).Diabetics showed lower CFI [(2.70±0.67)L/min vs.(3.64± 1.54)L/min,t =2.189,P =0.033],while patients with chronic obstructive pulmonary disease demonstrated a higher level of EVLWI[(13.83±7.60)l/min vs.(9.61±4.24)L/min,t =-2.062,P=0.045].On the third day,patients with high levels of PVPI showed an increased rate of mortality (80.0 ％,or 4 out of 5 cases to 28.9o,or 13 out of 45 cases,x2 =5.239,P=0.022),while the level of EVLWI of non-survivors was significantly higher than that of survivors on day 28[(11.10±5.57)ml/kg vs.(8.53±2.85)ml/kg,t=-2.150,P=0.037].Conclusions Elderly patients with septic shock have worse heart function,more lung water,and therefore lower volume tolerance than younger patients.The heart function of elderly patients deteriorates with age.PiCCO can provide real-time hemodynamic data and may be a prognostic index for elderly patients with septic shock.