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ORIGINAL ARTICLE
Year : 2017  |  Volume : 4  |  Issue : 4  |  Page : 195-202

Pulse index continuous cardiac output versus central venous pressure-based early goal-directed therapy for septic shock patients: a randomized trial


Department of Anaesthesia, Zagazig University Hospital, Zagazig, Egypt

Correspondence Address:
Mohamed T Ghanem
Department of Anesthesia and Surgical Intensive Care, Zagazig University Hospital, Zagazig University, Zagazig
Egypt
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/roaic.roaic_124_16

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Background Central venous pressure-based early goal-directed therapy (EGDT) is considered the gold standard in the management of septic shock. We compared this approach with pulse index continuous cardiac output (PiCCO)-based EGDT in a randomized controlled study. Patients and methods Eighty septic shock patients were randomly divided into the conventional survival sepsis bundle group using central venous and arterial catheters (group C, n=40), and the modified survival sepsis bundle group using central venous and PiCCO arterial thermistor catheters (group P, n=40). Primary outcome included mortality at 28 days after diagnosis of shock. Secondary outcomes included ICU stay, days on mechanical ventilation, and renal replacement therapy (RRT). Results In comparison with group C, group P showed a lower mortality with no statistical differences at 28 days after diagnosis of shock [15 (37.5%) patients in the P group vs. 21 (52.5%) patients in the C group; P=0.11]. The population in the C group showed longer duration on ventilation, which was statistically significant [6 (5.0–7.0) in the C group vs. 3 (2.0–3.0) in the P group; P<0.001]. Days on RRT and ICU stay were also statistically shorter in the P group [1 (0.0–2.0) in the P group vs. 4 (1.0–5.0) in the C control group; P<0.001 for duration on RRT and 5 (4.0–6.0) in the P group vs. 10 (6.0–16.0) in the C group; P<0.001 for ICU stay]. Conclusion PiCCO-based EGDT produced lower ICU stay, and shorter duration of ventilation and RRT; however, it did not reduce mortality in septic shock patients when compared with the conventional central venous pressure-based approach.


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