title: Hepatic Perfusion Alterations in Septic Shock Patients: Impact of Early Goal-directed Therapy.
abstract: BACKGROUND
  Early goal-directed therapy (EGDT) has become an important therapeutic management in early salvage stage of septic shock. However, splenic organs possibly remained hypoperfused and hypoxic despite fluid resuscitation. This study aimed to evaluate the effect of EGDT on hepatic perfusion in septic shock patients.
  
  
  METHODS
  A prospective observational study was carried out in early septic shock patients who were admitted to Intensive Care Unit within 24 h after onset and who met all four elements of the EGDT criteria after treatment with the standard EGDT procedure within 6 h between December 1, 2012 and November 30, 2013. The hemodynamic data were recorded, and oxygen metabolism and hepatic functions were monitored. An indocyanine green clearance test was applied to detect the hepatic perfusion. The patients' characteristics were compared before treatment (T0), immediately after EGDT (T1), and 24 h after EGDT (T2). This study is registered at ClinicalTrials.org, NCT02060773.
  
  
  RESULTS
  Twenty-one patients were included in the study; however, the hepatic perfusion data were not included in the analysis for two patients; therefore, 19 patients were eligible for the study. Hemodynamics data, as monitored by pulse-indicator continuous cardiac output, were obtained from 16 patients. There were no significant differences in indocyanine green plasma disappearance rate (ICG-PDR) and 15-min retention rate (R15) at T0 (11.9 ± 5.0%/min and 20.0 ± 13.2%), T1 (11.4 ± 5.1%/min and 23.6 ± 14.9%), and T2 (11.0 ± 4.5%/min and 23.7 ± 15.3%) (all P > 0.05). Both of the alterations of ICG-PDR and R15 showed no differences at T0, T1, and T2 in the patients of different subgroups that achieved different resuscitation goal numbers when elected (P > 0.05).
  
  
  CONCLUSIONS
  There were no hepatic perfusion improvements after EGDT in the early phase of patients with septic shock.
  
  
  BACKGROUND
  Clinicaltrials.gov NCT02060773 (https://clinicaltrials.gov/ct2/show/NCT02060773).
authors.affiliation: Department of Critical Care Medicine, School of Medicine, Zhongda Hospital, Southeast University, Nanjing, Jiangsu 210009, China.
authors.forename: Xi-Wen
authors.initials: XW
authors.lastname: Zhang
authors.affiliation: Department of Critical Care Medicine, School of Medicine, Zhongda Hospital, Southeast University, Nanjing, Jiangsu 210009, China.
authors.forename: Jian-Feng
authors.initials: JF
authors.lastname: Xie
authors.affiliation: Department of Critical Care Medicine, School of Medicine, Zhongda Hospital, Southeast University, Nanjing, Jiangsu 210009, China.
authors.forename: Ai-Ran
authors.initials: AR
authors.lastname: Liu
authors.affiliation: Department of Critical Care Medicine, School of Medicine, Zhongda Hospital, Southeast University, Nanjing, Jiangsu 210009, China.
authors.forename: Ying-Zi
authors.initials: YZ
authors.lastname: Huang
authors.affiliation: Department of Critical Care Medicine, School of Medicine, Zhongda Hospital, Southeast University, Nanjing, Jiangsu 210009, China.
authors.forename: Feng-Mei
authors.initials: FM
authors.lastname: Guo
authors.affiliation: Department of Critical Care Medicine, School of Medicine, Zhongda Hospital, Southeast University, Nanjing, Jiangsu 210009, China.
authors.forename: Cong-Shan
authors.initials: CS
authors.lastname: Yang
authors.affiliation: Department of Critical Care Medicine, School of Medicine, Zhongda Hospital, Southeast University, Nanjing, Jiangsu 210009, China.
authors.forename: Yi
authors.initials: Y
authors.lastname: Yang
authors.affiliation: Department of Critical Care Medicine, School of Medicine, Zhongda Hospital, Southeast University, Nanjing, Jiangsu 210009, China.
authors.forename: Hai-Bo
authors.initials: HB
authors.lastname: Qiu
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002302:Cardiac Output / Q000502:physiology; D019468:Disease Management; D005260:Female; D005440:Fluid Therapy; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012772:Shock, Septic / Q000628:therapy*