Research on the Impact of PiCCO-guided Precise Fluid Resuscitation on Hemodynamics and Organ Perfusion in Patients with Extremely Severe Burns

Abstract

Objective: To explore the impact of Pulse Indicator Continuous Cardiac Output (PiCCO) on hemodynamics and organ perfusion during fluid resuscitation in patients with extremely severe burns.

Methods: This study adopted a retrospective cohort study design. A total of 32 patients with extremely severe burns admitted to the Burn Department of the First Affiliated Hospital of Anhui Medical University from June 2022 to July 2024 were included. According to the monitoring methods, they were divided into a conventional monitoring group ( n = 17 ) and a PiCCO group ( n = 15 ). The basic data, fluid replacement indicators (total fluid replacement volume, urine output, fluid replacement coefficient, urine output per hour per kilogram of body weight), hemodynamic parameters [mean arterial pressure (MAP), central venous pressure (CVP), heart rate (HR), cardiac index (CI), cardiac output (CO), systemic vascular resistance index (SVRI), extravascular lung water index (EVLWI), global end-diastolic volume index (GEDVI), intrathoracic blood volume index (ITBVI)], laboratory indicators [lactate (Lac), base excess (BE), creatine kinase (CK), creatine kinase - MB (CK - MB), alanine aminotransferase (ALT), aspartate aminotransferase (AST), blood urea nitrogen (BUN), serum creatinine (Scr)] and clinical outcomes (complication incidence, 30 - day mortality, antibiotic use time, hospital stay and cost) of the two groups were compared. T-test, repeated-measures analysis of variance, Mann-Whitney U test, Bonferroni correction, chi-square test, and Fisher's exact probability method were used for statistical analysis.

Results: A comparison of the relevant indicators of patients with extremely severe burns between the PiCCO monitoring group and the conventional monitoring group showed no difference in the general conditions between the two groups ( P>0.05 ). The total fluid replacement volume in the PiCCO monitoring group was higher in the first, second, and third 24h periods after injury ( P<0.05 ), with no difference in urine output. The fluid replacement coefficient in the first and second 24h periods after injury was also higher ( P<0.05 ), and the urine output per hour per kilogram of body weight was higher than the planned value, but there was no difference between the groups. At 72 hours after injury, the MAP and CVP in the PiCCO monitoring group were higher, and the HR was lower ( P<0.05 ). At 72 hours after resuscitation, Lac and BUN in the PiCCO monitoring group were lower, and BE was higher ( P<0.05 ), with no differences in other indicators. In the PiCCO monitoring group, multiple hemodynamic indicators such as CI, CO, SVRI, EVLWI, GEDVI, and ITBVI showed obvious changing trends over time after injury, and these changes were statistically significant ( P<0.05 ), and these indicators returned to normal at different time points after injury. There were no significant differences in complications, 30-day mortality, antibiotic use days, hospital stay, and hospitalization costs between the two groups ( P>0.05 ).

Conclusion: PiCCO monitoring can optimize the early fluid resuscitation of patients with extremely severe burns by precisely regulating the volume status, improving tissue perfusion, and reducing the risk of organ damage. However, its impact on long-term prognosis needs to be further verified by multi-center and large-sample studies.