Clinical application value of PICCO monitoring based on early goal-directed fluid therapy in volume management of patients with severe multiple injuries

ObjectiveTo discuss the clinical application value of pulse indicator continuous cardiac output(PICCO) monitoring based on guidance of early goal-directed fluid therapy(EGDT) in patients with severe multiple injuries.

MethodsSixty patients with severe multiple injuries were divided into the control group and observation group by random number table method(30 cases in each group).The control group was given the capacity management under central venous pressure(CVP) monitoring, and the observation group was given the capacity management under PICCO.The critical degree score, changes of various physiological indexes and prognosis were compared between two groups, and the hemodynamic parameters changes were compared in the observation group between before and after treatment.

ResultsThe APACHE Ⅱ scores after 6, 24 and 48 h of treatment and ISS scores after 24 and 48 h of treatment in observation group were significantly lower than those in control group(P < 0.01).The differences of the heart rate, mean arterial pressure, serum lactic acid level, urine volume and PaO₂/FiO₂ after 6, 24 and 48 h of treatment between two groups were statistically significant(P < 0.05 to P < 0.01).The mechanical ventilation time, duration of ICU and 72 h total fluid resuscitation in observation group were significantly less than those in control group(P < 0.01), and the standard rate of 6 h fluid resuscitation in observation group was significantly higher than that in control group(P < 0.05), and there was no statistical significance in the 28 d mortality between two groups(P>0.05).The results of comparison within the observation group showed that the cardiac output index, intrathoracic blood volume index, total end-diastolic volume index and peripheral vascular resistance index increased after 6, 24 and 48 h of treatment increased(P < 0.05 to P < 0.01), and the extracascular pulmonary fluid index decreased significantly compared with before treatment(P < 0.05 to P < 0.01).

ConclusionsThe PICCO monitoring based on EGDT can be used in volume management of patients with severe multiple injuries, which can improve the severity, physiological indicators and hemodynamic status of patients, and has a certain effect on improving clinical treatment effect and prognosis.