Comparative analysis of the prognosis of fluid resuscitation in sepsis shock patients guided by radial artery applanation tonometry and critical care ultrasound: a retrospective cohort pilot study.

Abstract

Background: Hemodynamic monitoring is crucial for guiding fluid resuscitation in patients with Septic shock (SS). Radial artery applanation tonometry (RAAT) is faster and easier to operate and has been developed and used for continuous arterial pressure monitoring. However, there is no empirical evidence to confirm its benefit in the treatment of SS. The aim of this study was to investigate the clinical efficacy of two non-invasive hemodynamic monitoring techniques, namely RAAT and critical care ultrasound (CCUS)-guided interventions, in the treatment of fluid resuscitation in SS.

Methods: This single-center retrospective study included patients diagnosed with SS at our institution from 2021 to 2022. Patients were divided into two groups based on the hemodynamic monitoring method used: the RAAT group and the CCUS group. Twenty-eight-day mortality, intensive care unit (ICU) length of stay, Acute Physiology and Chronic Health Evaluation II (APACHE II) scores, incidence of renal failure, hemodynamic parameters, oxygenation index, Lac levels, Lac clearance, and procalcitoninogen (PCT) levels were assessed after fluid resuscitation in both groups.

Results: A total of 78 patients were included in the study, with 41 in the RAAT group and 37 in the CCUS group. There were no significant differences in demographic and baseline characteristics between the two groups except for SOFA, heart rate, MAP. early outcomes including 28 day mortality, 48 h oxygenation index, PCT levels and Acute Physiology and Chronic Health Evaluation II score, ICU stay, infusion volume, and incidence of renal failure. There was no significant difference in metabolic and hemodynamic indexes of Lac, Lac clearance, CVP, and 48 h MAP, and there was a significant difference in 24 h MAP between the CCUS group [68 (65, 71)] and the RAAT group [71 (67, 75)], P = 0.008.

Conclusion: In the fluid resuscitation of SS patients, the effects of the non-invasive hemodynamic monitoring methods RAAT and CCUS are comparable. In clinical application, the appropriate method can be selected according to the patient's specific situation, hospital resources, medical staff's proficiency and monitoring needs, or a combination of the two can be used in order to more comprehensively and accurately assess the patient's condition.