[The application of pulmonary artery catheterization in treatment of septic shock patients].

OBJECTIVE: To compare the differences of hemodynamic pattern and metabolic alteration between the survivors and nonsurvivors of septic shock so as to explore the value of pulmonary artery catheterization (PAC).

METHODS: A total of 70 patients with septic shock in whom PAC was carried out after initial resuscitation were retrospectively studied during a 5-year sequential period from 2001 to 2006 in a 15-bed general intensive care unit of a teaching hospital in Beijing, China. Hemodynamic data, lactate concentration and APACHEII score were obtained at the beginning and 24 hours later of PAC after the initial resuscitation period. The patients' outcome were recorded at the 28th day of hospitalization after diagnosis.

RESULTS: The overall mortality rate was 60%. There were no age and sex differences between the survivors and nonsurvivors. The nonsurvivor group had higher initial heart rate, APACHEII score and lactate concentration than the survivor group. After 24 hours, mean arterial pressure (MAP) was significantly lower, but central venous pressure (CVP), pulmonary arterial wedge pressure (PAWP), lactate concentration and APACHEII score of were significantly higher in the nonsurvivor group than those in the survivor group. There were no differences of the other hemodynamic date between the two groups in the beginning and 24 hours later. More patients received superhigh dosage of norepinephrine or dopamine in the nonsurvivor group. Achievement of superhigh concentration of oxygen delivery or early-goal directed therapy (EGDT) indices had no beneficial effect on survival. Multiple stepwise linear regression analysis showed 24-hour MAP, PAWP and initial heart rate were independent predictors of the outcome.

CONCLUSION: PAC can not display the differences of hemodynamic patterns between the survivors and nonsurvivors of septic shock after initial resuscitation, but 24 hours later nonsurvivors had higher PAWP significantly. Whether there are differences of hemodynamic pattern between the survivors and nonsurvivors was not the basis of PAC. The value of PAC monitoring is to balance the relationship between the requirement of hyperdynamic circulation and cardiac suppression state.