title: [Effect of resuscitation strategy based on the early goal directed therapy on the prognosis of patients with shock].
abstract: OBJECTIVE
  To evaluate the effects of fluid management strategies in early goal directed therapy (EGDT) on the prognosis of patients with shock.
  
  
  METHODS
  Clinical data of 79 patients with septic shock or hemorrhagic shock admitted to emergency intensive care unit (EICU) of the First People's Hospital of Yunnan Province were retrospectively analyzed. Patients were divided into continual fluid  administrating group (n=41) in accordance with protocol calculating approximating fluid volume and adjust the infusion speed based on blood pressure, heart rate, pulse saturation of blood oxygen (SpO(2)) and urine output with the end of fluid resuscitation was set to restore spontaneous circulation function and wean off vasoactive drugs, and the conservative fluid resuscitation group (n=38) by means of using vasoactive agents to maintenance blood pressure after infusing amount (20 ml/kg) of liquid early, respectively. The 28-day mortality and the time of using pressure agents were compared between two groups. According to the 28-day mortality, patients were further divided into the survival group (n=37) and death group (n=42), and acute physiology and chronic health evaluation II (APACHEII) score was compared between two groups. Logistic regression analysis of prognostic factors was conducted to identify and describe the relationship between the prognosis and fluid resuscitation methods and strategies.
  
  
  RESULTS
  The 28-day mortality of continual fluid administrating group was significantly lower than that of the conservative fluid resuscitation group (14.63% vs. 94.74%, P<0.01), total drugs supporting time (hours) was significantly shorter than that in conservative fluid resuscitation group (33.24±17.56 vs. 58.29±34.78, P<0.05). Thirty-six cases of 42 death patients received conservative fluid resuscitation (85.7%), but 35 cases of 37 survival patients received continual fluid administration (94.6%). Logistic regression analysis showed that odds ratio (OR) of brain natriuretic peptide before death or shifted out ICU was 0.9136, 95% confidence interval (95%CI) was 0.8125  to  0.9986, regression  coefficient  was -0.0931, P=0.0478, OR of procalcitonin before death or shifted out ICU was 0.9095, 95%CI was 0.8294 to 0.9973, regression coefficient was -0.0949, P=0.0436, and OR of blood lactate level before death or shifted out ICU was 0.5023, 95%CI was 0.2833 to 0.8905, regression coefficient was -0.6885, P=0.0184.
  
  
  CONCLUSIONS
  Ongoing fluid resuscitation early in accordance with method to theoretically calculate fluid volume and to adjust infusion speed based on blood pressure, heart rate, SpO(2) and urine, withdrawal of vasoactive drugs, the mortality of patients with shock was significantly reduced.
authors.affiliation: Department of Emergency Intensive Care Unit, First People's Hospital of Yunnan Province, Kunming, Yunnan, China.
authors.forename: Yan-fang
authors.initials: YF
authors.lastname: Zhang
authors.forename: Qiong-fen
authors.initials: QF
authors.lastname: Li
authors.forename: Lei
authors.initials: L
authors.lastname: Chen
authors.forename: Yi
authors.initials: Y
authors.lastname: Wang
authors.forename: Hui-ming
authors.initials: HM
authors.lastname: Wei
authors.forename: Chuan-yun
authors.initials: CY
authors.lastname: Qian
mesh_terms: D018806:APACHE; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D005260:Female; D005440:Fluid Therapy / Q000379:methods*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012151:Resuscitation / Q000379:methods; D012189:Retrospective Studies; D055502:Secondary Prevention; D012771:Shock, Hemorrhagic / Q000175:diagnosis* / Q000628:therapy*; D012772:Shock, Septic / Q000175:diagnosis* / Q000628:therapy*; D055815:Young Adult