Effect of Pulse Indicator Continuous Cardiac Output Monitoring on Septic Shock Patients: A Meta-Analysis

Abstract

Background. Septic shock (SS) is the most common severe syndrome in the Intensive Care Unit (ICU). Enhancing the monitoring of hemodynamic indexes in SS patients carries huge clinical implications for reducing patient mortality. Recently, pulse indicator continuous cardiac output (PICCO) has been widely used in clinical practice, but its advantages than central venous pressure (CVP) in guiding the treatment of SS patients remains to be refined. Therefore, this study is aimed at assessing the clinical effects of PICCO in the treatment of patients with SS. Methods. The authors systematically searched several databases (PubMed, EMBASE, Cochrane Library, and China National Knowledge) between January 2001 and February 2021. When searching for relevant articles, the authors combined the following phrases describing the monitoring group (“pulse indicator continuous cardiac output,” “central venous pressure”) with the disease of interest as well as management (“SS,” “sepsis”). The outcomes were independently assessed by two reviewers who scored the articles for methodological quality using the Cochrane Collaboration’s “risk of bias” tool. Forest plots, as well as sensitivity and bias analyses, were carried out for the included articles. The primary outcome measures were length of ICU stay, duration of mechanical ventilation, 28-day mortality, and fluid resuscitation volume. Results. Ten studies comprising 350 cases monitored with PICCO and 373 cases monitored with traditional CVP were eventually identified. PICCO-monitored patients were observed to be significantly associated with shorter ICU stay than CVP-monitored patients (MD: −3.04, 95% CI: −4.74 to −1.34, P = 0.0005 ), shorter time of mechanical ventilation (MD: −1.84, 95% CI: −2.80 to −0.87, P = 0.0002 ), and lower 28-day mortality (RR: 0.67, 95% CI: 0.48 to 0.94, P = 0.02 ). The two groups showed no significant difference in subgroup analysis for fluid resuscitation volumes ( P > 0.05 ). Conclusion. PICCO monitoring technique can significantly improve the prognosis of SS patients, shorten the time of mechanical ventilation and ICU stay, and reduce the 28-day mortality, which has positive guiding significance for patients with SS. Given the limitations of the quantity and quality of included studies, further research is warranted to verify the conclusions.

Which haemodynamic monitoring should we chose for critically ill patients with acute circulatory failure?

“…A recent meta-analysis included 10 studies comparing during septic shock management by TPTD rather than by monitoring alone of CVP. It showed that using TPTD reduced day-28 mortality and the duration of mechanical ventilation, with no difference in the volume of resuscitation fluid [42]. Nevertheless, this result is based on small studies with major methodological limitations.…”

Effect of pulse indicator continous cadiac output monitoring on prognosis of patients with acute respiratory distress syndrome: a meta-analysis

“…Previous meta-analysis has shown that PiCCO can improve the prognosis of patients with septic shock. Septic shock is closely related to ARDS 31 . Therefore, we believe that patients with ARDS may also bene t from PiCCO monitoring technology.…”

“…International guidelines for management of sepsis and septic shock 2021 suggests that aggressive uid resuscitation should be administered to patients with septic shock as soon as possible, but the subsequent infusion of uid required for intravenous administration can cause uid overload 36 . Therefore, PiCCO may improve the effect of uid resuscitation in patients with sepsis/septic shock with the reason that it can guide uid management through dynamic assessment of volume status in order to avoid uid overload while maintaining effective tissue perfusion 31 .…”