The application of Picco technology -guided fluid resuscitation in patients with ketoacidosis in ICU

• Published in: Journal of critical care 2024-06, Vol.81, p.154597, Article 154597
• Main Authors: Odajiu, Otilia, Bahov, Cornelia Gutu
• Format: Article
• Language: English
• Subjects: Acidosis; Critical care; Fluid therapy; Ketoacidosis; Length of stay; Medical prognosis; PiCCO monitoring
• ISSN: 0883-9441; 1557-8615
• DOI: 10.1016/j.jcrc.2024.154597

Ketoacidosis continues to be an important cause of ICU admissions among patients with diabetes. This study aims to evaluate the effect of fluid resuscitation on pathophysiology, organ function and clinical outcomes for critically ill patients. Fluid therapy is very important in ketoacidosis management, fluid overload has a high risk associated with impaired organ function and decreased survival in critically ill patients. Adequate fluid administration is key to successful ICU management. A total of 118 patients with ketoacidosis from ICU, Municipal Hospital, were included in prospective study, during a period of one year (January 1st to December 31th, 2022), patients were divided into 2 groups. Group I (n = 71) (mean age 41.8 ± 10.8 years) using PICCO technology for volemic resuscitation and group II (n = 47) (mean age 45.2 ± 12.1 years) by measuring static parameters. At admission to intensive care unit, the data showed patients from group I, had a higher score APACHE II and SOFA (group I (APACHE 21p ± 2.7; SOFA 12p ± 1,6) than group II (APACHE 18p ± 2.3, SOFA 10p ± 1.9), blood glucose >12 mmol/L, acidosis. Group I (n꞊71), 23 (32,3%) had mild (pH 7.26–7.35); 27 (38,02%) moderate (pH 7.11–7.25); and 21 (29,5%) severe acidosis (pH 3 mmol/L, and 24 (33,8%) of 71 had a normal lactate ≤3 mmol/L. Group II (n꞊47), 17(36,1%) had mild (pH 7.26–7.35); 21 (44,6%) moderate (pH 7.11–7.25); and 9 (19,1%) severe acidosis (pH 3 mmol/L, and 27 (57,4%) of 47 had a normal lactate ≤3 mmol/L. There was statistically significant difference in ICU length of stay between the two groups. The average length of stay in the ICU was (group I (3.2 days±1.2) vs group II (6.2 days±2.4). Patients from group I, had a shorter length of stay in the ICU. So the minimal duration of stay in ICU can avoid complications during hospitalization for patients with ketoacidosis. A significant reduction of lethal outcomes was observed in patients from group I (10.4%, P = 0.1) vs group II (15.7%). PiCCO monitoring is useful in fluid resuscitation to improve tissue perfusion, effect being better than conventional monitoring. It is a improvement in the survival rate of patients in group I vs group II, with a reduction of the ICU length of stay. The use of PICCO technology had a positive role on the prognosis of ICU patients, with a high survival rate.