Application and Nursing of Pulse Index Continuous Cardiac Output (PiCCO) Volume Monitoring in Early Fluid Resuscitation in Patients with Septic Shock

Background: Septic shock is a rapidly changing and fatal syndrome that can cause comprehensive deterioration of cardiopulmonary and renal function and multiple organ failure. At the same time, septic shock has the complex clinical manifestations and hemodynamics. PiCCO can accurately monitor blood flow, physical and volume indicators, and active and effective fluid resuscitation are important measures to reduce the fatality rate of septic shock and improve the prognosis of patients. Objectives: To explore the application and nursing of PiCCO in early fluid resuscitation in patients with septic shock. Methods: This was a retrospective observational study. The observation group and the control group each had 30 cases. The observation group used PiCCO to guide fluid resuscitation;the control group used conventional methods to guide fluid resuscitation. The changes in CVP, HR, MAP, and urine volume per hour were observed in the two groups. The changes of various indicators before and after fluid resuscitation, the length of stay in ICU and the mortality rate were compared between the two groups. All the outcomes were collected from the electronic medical case system after patients’ discharge from the hospital. Results: APACHE II, CVP, HR, MAP were compared between the observation group and the control group, and the differences were statistically significant (P < 0.05). The blood volume of patients in the observation group was significantly improved after fluid supplementation (P < 0.05). Compared with the control group, the length of stay in ICU in the observation group was significantly shorter, and the mortality rate was also significantly reduced (P < 0.05). Conclusion: PiCCO can be better used in early fluid resuscitation of patients with septic shock.

Contribution of Ambulatory Pulsed Pressure in the Modification of the Left Ventricular Geometry of the African Black People

Introduction-Purpose: Pulsed pressure is recognized as an important predictor of cardiovascular risk. The purpose of this study was to identify a possible association between high ambulatory pulsed pressure and left ventricular geometry change in African black people. Material and methods: We conducted a bicentric, retrospective descriptive and analytical study that took place from 2010 to 2015 at the Abidjan Heart Institute and the Polyclinic Sainte Anne Marie in Abidjan. The people were selected from MAPA’s archive files. Those aged 18 years and over were included, all of whom had valid echocardiography and MAPA. The analyzed parameters concerned epidemiological data with age, gender and body surface area. The clinical data analyzed included systolic, diastolic, mean and 24-hours pulsed pressures. On the echocardiographic parameters, it was the evaluation of the ventricular mass indexed to the body surface. Results: A total of 177 patients records were selected. The mean age of the patients was 56.32 ± 10.51 years. There was a male predominance with a sex ratio of 1.15. The main cardiovascular risk factors found outside high blood pressure were dyslipidemia (06.87%) and obesity (13.7%). In clinical terms, hypertension was found in 75% of cases (n = 133) versus 25% (n = 44) of normotensive patients. These blood pressure profiles allowed us to classify our study population into two groups: hypertensives people and normotensives people. The hypertensives people had significantly higher mean pulsed pressure levels than the normotensives people. All normotensive patients had normal pulsed pressure. In the hypertensive population, the prevalence of high pulsed pressure was 31% (n = 41) versus 69% (n = 92) normal pulsed pressure. Concerning the relationship between 24 hour ambulatory pulsed pressure and left ventricular mass, hypertensives patients with a high ambulatory pulsed pressure had a significantly higher average indexed ventricular mass than the opposite groups (p = 0.039). Their ejection fraction was significantly lower than those of the opposite populations (p = 0.000). On the analysis of the correlation between the left ventricular mass and the tension profile, we noted in our series, a strong and significant correlation (r = 0.6342;p = 0.0000) between pulsed pressure and the ventricular geometry change. Conclusion: High ambulatory pulsed pressure remains an independent factor of change in left ventricular geometry in black people.

Difference analysis of Doppler ultrasound blood flow of Cunkou(radial artery)pulse,Renying(carotid artery)pulse,and Fuyang(anterior tibial artery)pulse

OBJECTIVE:To analyze the Doppler ultrasound blood flow of Renying(carotid artery)pulse,Cunkou(radial artery)pulse,and Fuyang(anterior tibial artery)pulse in the normal group and the functional constipation with gastrointestinal heat(FCGH)group,and to compare and explore the differences of Renying,Cunkou and Fuyang pulses.METHODS:Sixty normal subjects and 60 patients with gastrointestinal heat constipation were collected in the department of ultrasound,Beijing Anzhen Hospital,Capital Medical University.Doppler ultrasound was used to observe the blood flow indexes including maximum systolic velocity(Vp),maximum diastolic velocity(Vd),mean velocity(Vm),pulse index(PI),resistance index(RI),vascular diameter(D),and circulation blood flow cycle(ET)of Renying pulse,Cunkou pulse and Fuyang pulse in the normal group and patients with gastrointestinal heat constipation.The differences of these three pulses were compared between the normal group and the FCGH group.RESULTS:The PI,Vp,Vm,RI,and D of the three pulses in the normal group were statistically significant different(P<0.01).In the comparison of Doppler flow diagram of three pulses in the FCGH group,there were significant differences in PI,Vd,Vp,Vm,RI,and D(P<0.01).CONCLUSION:Under normal conditions,the indexes of Renying pulse Doppler flow diagram,Cunkou pulse Doppler flow diagram,and Fuyang pulse Doppler flow diagram are significantly different.In the FCGH group,most of the indexes of Renying pulse Doppler flow diagram,Cunkou pulse Doppler flow diagram,and Fuyang pulse Doppler flow diagram are different.This result verified the necessity of simultaneous examinations of all Renying,Cunkou,and Fuyang pulses in modern Chinese medicine.

Evaluation of respiratory dysfunction in a pig model of severe acute dichlorvos poisoning

Background Respiratory failure is the main cause of death in acute organophosphorus pesticide poisoning. In this study, a pulse-induced contour cardiac output monitor was used to evaluate the respiratory status in a pig model of acute dichlorvos poisoning. Methods Twenty female pigs were randomly allocated to dichlorvos （n=7）, atropine （n=7）, and control （n=6） groups. In the dichlorvos group, pigs were administered 80% emulsifiable dichlorvos （100 mg/kg） via a gastric tube. In the atropine group, pigs were similarly administered dichlorvos, and 0.5 hours later, atropine was injected to attain and maintain atropinization. The control group was administered saline solution. Arterial blood gas was measured at 0, 0.5, 1, 2, 4, and 6 hours post-injection. The extravascular lung water index and pulmonary vascular permeability index were recorded by the pulse-induced contour cardiac output monitor. At termination of the study, the animals were euthanized, the lung wet-to-dry weight ratio was determined, and histopathology was observed. Results In the dichlorvos group, the extravascular lung water index and pulmonary vascular permeability index were substantially increased from 0.5 hours and were particularly high within 1 hour. In the atropine group, these indices increased initially, but decreased from the 1-hour mark. The control group exhibited no obvious changes. In both the dichlorvos and atropine groups, the extravascular lung water index was negatively correlated with partial pressure of oxygen/fraction of inspiration oxygen （POz/FiO2） and positively correlated with the pulmonary vascular permeability index. Compared with the control group, the lung wet-to-dry weight ratio markedly increased and the histopathological findings obviously changed in the dichlorvos group, but only mildly increased and changed, respectively, in the atropine group. Conclusion The extravascular lung water index is an appropriate and valuable parameter for assessment of respiratory function in acute dichlorvos poisoning.