Hepatic Perfusion Alterations in Septic Shock Patients: Impact of Early Goal-directed Therapy

摘要

Background:Early goal-directed therapy (EGDT) has become an important therapeutic management in early salvage stage of septic shock.However,splenic organs possibly remained hypoperfused and hypoxic despite fluid resuscitation.This study aimed to evaluate the effect of EGDT on hepatic perfusion in septic shock patients.Methods:A prospective observational study was carried out in early septic shock patients who were admitted to Intensive Care Unit within 24 h after onset and who met all four elements of the EGDT criteria after treatment with the standard EGDT procedure within 6 h between December 1,2012 and November 30,2013.The hemodynamic data were recorded,and oxygen metabolism and hepatic functions were monitored.An indocyanine green clearance test was applied to detect the hepatic perfusion.The patients' characteristics were compared before treatment (T0),immediately after EGDT (T 1),and 24 h after EGDT (T2).This study is registered at ClinicalTrials.org,NCT02060773.Results:Twenty-one patients were included in the study;however,the hepatic perfusion data were not included in the analysis for two patients;therefore,19 patients were eligible for the study.Hemodynamics data,as monitored by pulse-indicator continuous cardiac output,were obtained from 16 patients.There were no significant differences in indocyanine green plasma disappearance rate (ICG-PDR) and 15-min retention rate (R15) at T0 (11.9 ± 5.0％/min and 20.0 ± 13.2％),T 1 (11.4 ± 5.1％/min and 23.6 ± 14.9％),and T2 (11.0 ± 4.5％/min and 23.7 ± 15.3％) (all P ＞ 0.05).Both of the alterations of ICG-PDR and R1 5 showed no differences at T0,T1,and T2 in the patients of different subgroups that achieved different resuscitation goal numbers when elected (P ＞ 0.05).Conclusion:There were no hepatic perfusion improvements after EGDT in the early phase of patients with septic shock.