Effects of different goal-directed therapies on cerebral oxygen metabolism and S100β level in patients with sepsis-induced hypoperfusion
Received:November 10, 2018  
View Full Text  View/Add Comment  Download reader
DOI:10.11915/j.issn.1671-5403.2019.03.034
Key words:goal-directed therapy  sepsis  hypoperfusion  cerebral oxygen metabolism  S100β
Author NameAffiliationE-mail
HUANG Yi-Zhou Jiangsu Provincial Key Laboratory of Anesthesiology, Xuzhou Medical University, Xuzhou 221004, China  
WU Bian-Liang Jiangsu Provincial Key Laboratory of Anesthesiology, Xuzhou Medical University, Xuzhou 221004, China  
LIU Yue Jiangsu Provincial Key Laboratory of Anesthesiology, Xuzhou Medical University, Xuzhou 221004, China  
YUAN Lin-Fang Jiangsu Provincial Key Laboratory of Anesthesiology, Xuzhou Medical University, Xuzhou 221004, China  
GENG Xiao-Juan Intensive Care Unit, the Affiliated Hospital of Xuzhou Medical University, Xuzhou 221000, China  
ZHAO Wen-Jing Jiangsu Provincial Key Laboratory of Anesthesiology, Xuzhou Medical University, Xuzhou 221004, China zhaowj886@163.com 
Hits: 1178
Download times: 792
Abstract:
      Objective To compare the effects of 2 different goal-directed therapies on cerebral oxygen metabolism and S100β level in patients with sepsis-induced hypoperfusion. Methods From May 2017 to August 2018, a total of 60 patients with sepsis-induced hypoperfusion, who required mechanical ventilation and were admitted to the Intensive Care Unit of the Affiliated Hospital of Xuzhou Medical University were randomly divided into modified early goal-directed therapy group (group M) and standard therapy group (group S), with 30 patients in each group. In group M, fluid resuscitation was guided by 2016 Surviving Sepsis Campaign Interna-tional Guidelines for Management of Sepsis and Septic Shock combined with stroke volume variation (SVV) monitored by FloTrac/Vigileo system, and then the following goals were required to reach during the first 6 h of therapy:SVV ≤13%, mean arterial pressure (MAP) ≥65 mmHg(1 mmHg=0.133 kPa), and lactate clearance rate ≥10% or lactic acid (Lac) <2.0 mmol/L. In group S, the first 6 h of fluid resuscitation was directed by the goals of systolic blood pressure (SBP) ≥100 mmHg and shock index (SI) <0.8. The regional oxygen saturation (rSO2), serum S100β level, jugular venous oxygen saturation (SjvO2), arteriovenous blood oxygen content difference (Da-jvO2), cerebral extraction rate of oxygen (CERO2), hemodynamic parameters, serum Lac level, acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score were compared between the 2 groups at pre-resuscitation (T1), first 6 h of resuscitation (T2), 24 h of resuscitation (T3), and 48 h of resuscitation (T4). Meanwhile, the volume of intravenous fluid infusion within 48 h, proportion of the patients receiving vasopressor, incidence rate of adverse cardiac and cerebral vascular events, length of intensive care unit (ICU) and hospital stay, and hospital mortality were recorded and compared between the 2 groups. Results The levels of rSO2 and SjvO2 were significantly increased, and those of Da-jvO2, CERO2 and S100β were obviously decreased at T2-T4 than at T1 in both groups (P<0.05). In the group M, the rSO2 level was significantly higher [(66.7±2.6) % vs (63.4±1.8)%] and S100β level was notably lower [(0.29±0.04) vs (0.34±0.04)μg/L)] at T2, the level of SjvO2 [(68.5±2.5) % vs (65.7±1.2)%, (71.3±2.3)% vs (68.0±2.6)%] was remarkably increased and those of Da-jvO2 [(51.8±3.8)% vs (54.3±2.6)%, (44.5±2.6)% vs (48.3±3.9)%] and CERO2 [(31.7±2.2)% vs (33.2±1.4)%, (27.6±1.6)% vs (33.0±2.5)%] were significantly lower at T3-T4 when compared with the group S (all P<0.05). Compared with the values at T1, those of MAP and central venous pressure (CVP) were significantly increased and those of heart rate (HR), Lac level and APACHE Ⅱ score decreased at T2-T4 in both groups (P<0.05). At T2, the group M had significantly lower CVP [(8.5±1.0) vs (10.0±1.3)cmH2O] and less amount of intravenous fluid infusion [(2 783±307) vs (3 087±382)ml] than the other group (P<0.05). There were no statistical differences in the length of ICU and hospital stay, incidence rate of adverse cardiac and cerebral vascular events, and hospital mortality between the 2 groups (P>0.05). Conclusion The modified early goal-directed therapy based on SVV and lactate clearance rate is superior to the standard therapy not only in optimization of cerebral oxygen metabolism balance, but also in improvement of cerebral perfusion and attenuation of brain injury during the early resuscitation.
Close