ObjectiveTo explore the value of inferior vena cava inspiratory collapsibility (ΔIVC) in guiding septic shock resuscitation with early goal-directed therapy (EGDT).MethodsA single center, randomized controlled trial was conducted at an 812-bed hospital in Mianyang, Sichuan. Adult patients with early septic shock in the intensive care unit were assessed and treated at defined intervals over 6 h using an ΔIVC-guided resuscitation protocol or an EGDT protocol. Feasibility outcomes were fluid balance and norepinephrine administration. The primary clinical outcomes were in-hospital mortality rate, 90-day survival rate. Secondary outcomes included incidence of acute kidney injury and consumption of health resources.ResultsSixty-eight patients with septic shock were enrolled in this study. Baseline characteristics were similar between the two groups. The ΔIVC-guided septic shock resuscitation group was lower than the EGDT group in the ICU 24 h fluid replacement (L): 3.8 (4.0, 5.3) vs. 4.7 (4.0, 6.6), 72 h liquid positive balance (L): 0.2 (–0.65, 1.2) vs. 2.5 (0.0, 4.1), intensive care unit length of stay (d): 7.5 (5.0, 14.0) vs. 15.0 (7.0, 21.5), mechanical ventilation cumulative time (d): 3.0 (0.0, 7.0) vs. 7.5 (2.2, 12.0), ICU costs (ten thousand yuan): 3.4 (2.1, 5.9) vs. 8.6 (4.2, 16.5), bedside blood purification treatment costs (ten thousand yuan): 2.3 (1.1, 3.3) vs. 6.8 (2.1, 10.0) (P<0.05). No difference was observed in the incidence of acute kidney injury (P > 0.05), in-hospital mortality and 90-day survival between the two groups (log-rank χ2=0.35, P>0.05).ConclusionsAmong patients with septic shock, a ΔIVC-guided septic shock resuscitation, compared with EGDT, did not reduce in-hospital mortality. It might prevent the risk of over resuscitation, shorten the duration of mechanical ventilation, and lead to a better utilization of intensive care unit resources.
Objective To investigate the prognostic factors related to in-hospital mortality in patients with acute exacerbation of chronic obstructive pulmonary disease ( AECOPD) . Methods A prospective cohort study was carried out in AECOPD patients admitted in three district general hospitals of Jiangyou city, Sichuan province from February 2007 to February 2008. The clinical and epidemiological data at admission and all-cause death in hospital were recorded. The in-hospital mortality rate and potential determinants of mortality of AECOPD were analyzed using Logistic regression method. Results 257 AECOPD inpatients with AECOPD were recruited into the cohort study. The in-hospital mortality rate was 5.84% (15/257) . Univariate analysis showed in-hospital mortality was significantly associated with age, FEV1% pred, arterial oxygen tension ( PaO2 ) , arterial oxygen saturation ( SaO2 ) , pH, and Charlson’s complication index. Multivariate logistic regression model showed that lower arterial oxygen tension ( OR 4.775;95%CI 1.545 ～14.757; P =0.007) and higher Charlson’s complication index ( OR 4. 608; 95% CI 1. 330 ～15. 966; P =0. 016) were significantly associated with in-hospital mortality after adjustment by age. Conclusion For in-patients with AECOPD, PaO2 and Charlson’s complication index are independent risk factors associated with in-hospital mortality.