Objective: To evaluate the therapeutic effect of early fluid resuscitation under the guidance of pulse indicator continuous cardiac output (PiCCO) on patients with severe acute pancreatitis (SAP).
Methods: Clinical data of 18 SAP patients (research group), who had undergone fluid resuscitation under the guidance of PiCCO in the Department of Critical Care Medicine of the Second Affiliated Hospital of Anhui Medical University from October 2011 to October 2013, were analyzed prospectively. At the same time, clinical data of 25 cases (control group) that had undergone fluid resuscitation without the guidance of PiCCO from January 2009 to September 2011 were collected retrospectively. The volume of fluid and clinical data were compared between two groups.
Results: During the first 6 hours, 0-24 hours, 24-48 hours, and 0-72 hours after intensive care unit (ICU) admission, the research group received larger volume of fluid than that of the control group (2 133 ± 1 593 mL vs. 1 024 ± 421 mL, t=3.337, P=0.002; 5 960 ± 2 951 mL vs. 3 767 ± 854 mL, t=3.531, P=0.001; 4 709 ± 1 508 mL vs. 3 863 ± 1 122 mL, t=2.112, P=0.031; 14 601 ± 5 095 mL vs. 11 409 ± 2 667 mL, t=2.673, P=0.007). Compared with the control group, the incidence of application of blood purification was lowered [5.56% (1/18) vs. 44.00% (11/25), χ² = 7.688, P=0.006], the duration of the systemic inflammatory response syndrome (SIRS) was shortened (3.54 ± 2.44 days vs. 5.62 ± 3.62 days, t=2.113, P=0.041), acute physiology and chronic health II (APACHEII) score was significantly declined at 24 hours after admission (11 ± 4 vs. 14 ± 5, t=2.104, P=0.042), the blood lactic acid was decreased more significantly after 72 hours (3.10 ± 0.55 mmol/L vs. 2.40 ± 1.12 mmol/L, t=2.442, P=0.019), and the length of ICU stay was shortened (10 ± 9 days vs. 20 ± 10 days, t=3.371, P=0.002) in research group. But there was no significant difference in the percentage of the use of vasoactive drugs [16.67% (3/18) vs. 24.00% (6/25), χ² =0.340, P=0.560], the incidence of invasive mechanical ventilation [50.00% (9/18) vs. 52.00% (13/25), χ² = 0.017, P=0.897], 72-hour urea nitrogen changes (-0.33 ± 4.71 mmol/L vs. -0.09 ± 5.37 mmol/L, t=0.152, P=0.880), and the percentage of abdominal infection[16.67% (3/18) vs. 16.00% (4/25), χ² = 0.003, P=0.953] between research group and control group. The mortality in research group was lower than that in control group [5.56% (1/18) vs. 20.00% (5/25)] without statistical difference (χ² = 1.819, P=0.178). According to the 2012 Atlanta classification, patients were re-evaluated after 48 hours fluid resuscitation. Six patients in research group developed moderately severe acute pancreatitis, and the incidence was significantly higher than that in control group [33.33% (6/18) vs. 8.00% (2/25), χ² = 4.435, P=0.034]. The time of mean PiCCO installation was 4.5 days in 18 cases of the research group, and no related complications occurred.
Conclusions: The PiCCO device may be a useful adjunct for fluid resuscitation monitoring in patients with SAP within 72 hours. Early fluid resuscitation under the guidance of PiCCO may be helpful in improving tissue perfusion, reducing the application of blood purification, as well as shortening length of ICU stay. This program did not increase the risk of invasive mechanical ventilation, and no obvious change in mortality rate was observed.