Guiding effect of noninvasive monitoring of cardiac output and central venous oxygen saturation on early goal-directed fluid resuscitation in hyperlipidemic severe acute pancreatitis

Hongsheng WU; Keqiang MA; Biling LIAO; Tengfei JI; Jianbin HUANG; Tiansheng CAO

doi:10.3969/j.issn.1001-5256.2022.07.026

Volume 38 Issue 7

Jul. 2022

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Article Navigation > Journal of Clinical Hepatology > 2022 > 38(7): 1602-1607

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Guiding effect of noninvasive monitoring of cardiac output and central venous oxygen saturation on early goal-directed fluid resuscitation in hyperlipidemic severe acute pancreatitis

DOI: 10.3969/j.issn.1001-5256.2022.07.026

Department of Hepatobiliary and Pancreatic Surgery, The People's Hospital of Huadu District, Guangzhou 510800, China

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Corresponding author: CAO Tiansheng, caotiansheng2088@sina.com(ORCID: 0000-0002-4926-570X)
Received Date: 2021-11-25
Accepted Date: 2022-01-11
Published Date: 2022-07-20

Abstract

Abstract

Objective To investigate the guiding effect of noninvasive monitoring of cardiac output (CO) and central venous oxygen saturation (ScvO₂) on early goal-directed fluid resuscitation in patients with hyperlipidemic severe acute pancreatitis. Methods A total of 84 patients with hyperlipidemic severe acute pancreatitis who were admitted to the People's Hospital of Huadu District from January 2018 to December 2020 were enrolled as subjects and randomly divided into research group and control group, with 42 patients in each group. In the control group, goal-directed fluid resuscitation was performed by monitoring mean arterial pressure and central venous pressure, and in the research group, goal-directed fluid resuscitation was guided by the dynamic monitoring of CO through a bedside Doppler noninvasive hemodynamic detector and the monitoring of ScvO₂ through PreSep central venous catheter. The two groups were compared in terms of time to early volume reaching standard (hour), time to relief of abdominal pain (day), time to gastrointestinal function recovery (day), time to triglyceride (TG) recovery (day), lactate clearance rate at 6 hours after treatment, change of Acute Physiology and Chronic Health Evaluation Ⅱ (APACHE-Ⅱ) score from before treatment to days 3 and 7 after treatment, and early complications of acute pancreatitis. The t-test was used for comparison of continuous data between groups, and the chi-square test was used for comparison of categorical data between groups. Results Compared with the control group, the research group had significantly shorter time to volume reaching standard (8.7±1.6 hours vs 19.6±2.1 hours, t=-18.86, P < 0.05), time to relief of abdominal pain (3.4±1.2 days vs 5.8±1.5 days, t=-16.74, P < 0.05), time to gastrointestinal function recovery (5.6±2.3 days vs 8.2±2.5 days, t=-11.74, P < 0.05), and time for TG to decrease to the normal level (5.5±1.6 days vs 9.7±1.7 days, t=10.76, P < 0.05). Compared with the control group, the research group had a significantly lower APACHE-II score on days 3 and 7 (day 3: 11.86±1.88 vs 20.75±1.63, t=-17.36, P < 0.05; day 7: 6.21±1.13 vs 14.36±1.53, t=-18.41, P < 0.05), a significantly lower arterial blood lactate level at 6 hours after admission (4.24±0.23 mmol/L vs 5.07±0.17 mmol/L, t=-17.76, P < 0.05), and a significantly higher arterial blood lactate clearance rate at 6 hours (23.74%±0.44% vs 10.74%±0.67%, t=-17.73, P < 0.05). The comparison of early complications showed that compared with the control group, the research group had significantly lower incidence rates of peripancreatic acute necrotic collection (4.76% vs 19.05%, χ²=16.63, P < 0.05), pulmonary infection (9.52% vs 38.10%, χ²=15.78, P < 0.05), pleural effusion (35.71% vs 88.10%, χ²=8.96, P < 0.05), gastrointestinal bleeding (7.14% vs 16.67%, χ²=7.45, P < 0.05), and organ failure (11.90% vs 30.95%, χ²=7.96, P < 0.05). Conclusion Noninvasive monitoring of CO and ScvO₂ in clinical practice has an important guiding significance for early goal-directed fluid resuscitation in patients with hyperlipidemic severe acute pancreatitis and can significantly improve the clinical treatment outcome of hyperlipidemic severe acute pancreatitis.
- Pancreatitis, Acute Necrotizing,
- Hyperlipidemias,
- Resuscitation,
- Cardiac Output,
- Blood Gas Analysis

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References

[1]	ZHU L, ZHU Y, HE WH, et al. Clinical characteristics analysis of 2625 acute pancreatitis in Jiangxi Province[J]. Chin J Dig, 2014, 34(8): 531-534. DOI: 10.3760/cma.j.issn.0254-1432.2014.08.006. 朱亮, 祝荫, 何文华, 等. 江西省2625例急性胰腺炎临床特征分析[J]. 中华消化杂志, 2014, 34(8): 531-534. DOI: 10.3760/cma.j.issn.0254-1432.2014.08.006.
[2]	BRADLEY EL 3rd. A clinically based classification system for acute pancreatitis. Summary of the International Symposium on Acute Pancreatitis, Atlanta, Ga, September 11 through 13, 1992. [J]. Arch Surg, 1993, 128(5): 586-590. DOI: 10.1001/archsurg.1993.01420170122019.
[3]	Chinese Society for Emergency Medicine; Beijing-Tianjin-Hebei Alliance of Emergency Treatment and First Aid; Emergency Medicine Branch, Beijing Medical Association, et al. Expert consensus on emergency diagnosis and treatment of acute pancreatitis[J]. J Clin Hepatol, 2021, 37(5): 1034-1041. DOI: 10.3969/j.issn.1001-5256.2021.05.012. 中华医学会急诊分会, 京津冀急诊急救联盟, 北京医学会急诊分会, 等. 急性胰腺炎急诊诊断及治疗专家共识[J]. 临床肝胆病杂志, 2021, 37(5): 1034-1041. DOI: 10.3969/j.issn.1001-5256.2021.05.012.
[4]	MINHAS J, THAKKAR D, DARGIN J. Hypertriglyceridemia-induced acute pancreatitis[J]. J Emerg Med, 2017, 52(3): e89-e90. DOI: 10.1016/j.jemermed.2016.10.018.
[5]	VINCENT JL, MORENO R, TAKALA J, et al. The SOFA (Sepsis-related Organ Failure Assessment) score to describe organ dysfunction/failure. On behalf of the Working Group on Sepsis-Related Problems of the European Society of Intensive Care Medicine[J]. Intensive Care Med, 1996, 22(7): 707-710. DOI: 10.1007/BF01709751.
[6]	BANKS PA, BOLLEN TL, DERVENIS C, et al. Classification of acute pancreatitis-2012: revision of the Atlanta classification and definitions by international consensus[J]. Gut, 2013, 62(1): 102-111. DOI: 10.1136/gutjnl-2012-302779.
[7]	YAN S, LI Y, FAN JY, et al. Comparison of clinical features between hypertriglyceridemia-induced acute pancreatitis and biliary acute pancreatitis[J/CD]. Chin J Hepat Surg(Electronic Edition), 2020, 9(5): 445-448. DOI: 10.3877/cma.j.issn.2095-3232.2020.05.011. 严舒, 李勇, 范婧妍, 等. 高甘油三酯血症急性胰腺炎与胆源性急性胰腺炎临床特征比较[J/CD]. 中华肝脏外科手术学电子杂志, 2020, 9(5): 445-448. DOI: 10.3877/cma.j.issn.2095-3232.2020.05.011.
[8]	AN WH, YANG J, HE XC, et al. Clinical features of hyperlipidemic acute pancreatitis and their association with lipid metabolism[J]. J Clin Hepatol, 2020, 36(4): 860-864. DOI: 10.3969/j.issn.1001-5256.2020.04.030. 安文慧, 杨婧, 何旭昶, 等. 高脂血症性急性胰腺炎的临床特征及其与脂代谢的关系[J]. 临床肝胆病杂志, 2020, 36(4): 860-864. DOI: 10.3969/j.issn.1001-5256.2020.04.030.
[9]	VALDIVIELSO P, RAMíREZ-BUENO A, EWALD N. Current knowledge of hypertriglyceridemic pancreatitis[J]. Eur J Intern Med, 2014, 25(8): 689-694. DOI: 10.1016/j.ejim.2014.08.008.
[10]	YAN YF, JIANG X, ZHONG R, et al. Association of the duration of systemic inflammatory response syndrome with infectious pancreatic necrosis at the initial stage of acute pancreatitis[J]. J Clin Hepatol, 2021, 37(3): 654-659. DOI: 10.3969/j.issn.1001-5256.2021.03.029. 严永峰, 蒋鑫, 钟瑞, 等. 急性胰腺炎初期全身炎症反应综合征持续时间与感染性胰腺坏死的关系[J]. 临床肝胆病杂志, 2021, 37(3): 654-659. DOI: 10.3969/j.issn.1001-5256.2021.03.029.
[11]	WU YQ, ZHAO JC. Predictive value of Ranson score in the classification of moderate to severe hyperlipidemia acute pancreatitis[J]. J Clin Exp Med, 2022, 21(2): 222-225. DOI: 10.3969/j.issn.1671-4695.2022.02.029. 吴永强, 赵景成. Ranson评分在高脂血症性急性胰腺炎病情严重程度评估中的应用价值[J]. 临床和实验医学杂志, 2022, 21(2): 222-225. DOI: 10.3969/j.issn.1671-4695.2022.02.029.
[12]	GARDNER TB, VEGE SS, PEARSON RK, et al. Fluid resuscitation in acute pancreatitis[J]. Clin Gastroenterol Hepatol, 2008, 6(10): 1070-1076. DOI: 10.1016/j.cgh.2008.05.005.
[13]	XU C, PENG J, LIU S, et al. Goal-directed fluid therapy versus conventional fluid therapy in colorectal surgery: A meta analysis of randomized controlled trials[J]. Int J Surg, 2018, 56: 264-273. DOI: 10.1016/j.ijsu.2018.06.034.
[14]	HUH JW, OH BJ, LIM CM, et al. Comparison of clinical outcomes between intermittent and continuous monitoring of central venous oxygen saturation (ScvO₂) in patients with severe sepsis and septic shock: a pilot study[J]. Emerg Med J, 2013, 30(11): 906-909. DOI: 10.1136/emermed-2012-201356.
[15]	SUN Y, LU ZH, ZHANG XS, et al. The effects of fluid resuscitation according to PiCCO on the early stage of severe acute pancreatitis[J]. Pancreatology, 2015, 15(5): 497-502. DOI: 10.1016/j.pan.2015.06.006.
[16]	YANG ZY, WANG HL. The application of PiCCO in the early fluid resuscitation in patients with severe acute pancreatitis and ARD[J]. Chin J Crit Care Med, 2015, 35(11): 999-1002. DOI: 10.3969/j.issn.1002-1949.2015.11.009. 杨震宇, 王洪亮. PiCCO在重症急性胰腺炎并ARDS患者早期液体复苏中的应用[J]. 中国急救医学, 2015, 35(11): 999-1002. DOI: 10.3969/j.issn.1002-1949.2015.11.009.
[17]	BORTOLOTTI P, SAULNIER F, COLLING D, et al. New tools for optimizing fluid resuscitation in acute pancreatitis[J]. World J Gastroenterol, 2014, 20(43): 16113-16122. DOI: 10.3748/wjg.v20.i43.16113.
[18]	GONG XY, LI GF, ZANG B. The effects of fluid resuscitation on oxygenation index and prognosis in early stage of severe acute pancreatitis[J]. Chin Critical Care Med, 2014, 26(8): 576-580. https://www.cnki.com.cn/Article/CJFDTOTAL-ZSSA201615048.htm 龚晓莹, 李国福, 臧彬. 重症急性胰腺炎早期液体复苏对氧合指数及预后的影响[J]. 中华危重病急救医学, 2014, 26(8): 576-580. https://www.cnki.com.cn/Article/CJFDTOTAL-ZSSA201615048.htm

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Guiding effect of noninvasive monitoring of cardiac output and central venous oxygen saturation on early goal-directed fluid resuscitation in hyperlipidemic severe acute pancreatitis

DOI: 10.3969/j.issn.1001-5256.2022.07.026

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