Value of blood perfusion index in guiding fluid resuscitation against septic shock

Abstract

ObjectiveSeptic shock is a serious medical condition characterized by extreme inflammation and blood vessel permeability. Fluid resuscitation is a crucial treatment for septic shock, but the optimal approach for fluid management remains controversial. In this study, we explored how blood perfusion index (PI) monitoring can help direct fluid resuscitation therapy for septic shock.MethodsBetween January 2019 and December 2021, 50 patients with septic shock were admitted to The Affiliated Hospital of Hangzhou Normal University and randomly assigned to either a control or study group (25 cases each). All patients were given the sepsis treatment bundle recommended by the 2018 guidelines and were subjected to Pulse Indicator Continuous Cardiac Output (PiCCO) -based hemodynamic monitoring. Fluid resuscitation was administered based on specific indicators in the control group. We used PI to direct fluid resuscitation in the research group. Several parameters were assessed, including blood lactate (BLAC), hemoglobin (Hb), stroke volume index (SVI), norepinephrine dosage, extravascular lung water (EVLW), volume of resuscitation fluid and the ICU mortality.ResultsThere were statistically significant reductions in BLAC in the study group compared to the control group 6 h, 24 h, and 48 h after treatment (P < 0.05). In the study group, the SVI was higher 24 and 48 h post-treatment compared to the control group (P < 0.05). Norepinephrine doses were similarly lowered in the study group. In the comparison of extravascular lung water between the two groups, the extravascular lung water in the study group was less than that in the control group 24 h after fluid resuscitation, and the difference was statistically significant. the ICU mortality [44%vs. 56% (X² = 0.720, P = 0.572)] in the study group were lower than those in the control group, but the difference had no statistical significance.ConclusionsIn patients with septic shock, fluid resuscitation guided by PI monitoring improves BLAC and SVI while decreasing norepinephrine dosage, and avoid the risk of fluid overload due to increased EVLW fluid overload, demonstrating clinical significance and application value.

Keywords: fluid resuscitation; perfusion index; septic shock.