[The clinical application and value of intra-aortic balloon pump in patients with septic shock].

OBJECTIVE

To investigate the clinical efficacy and value of intra-aortic balloon pump (IABP) with vasoactive drugs for septic shock patients.

METHODS

A method of single-centre registry was conducted. Data were collected from 78 consecutive septic shock patients in late stage in intensive care unit (ICU) of Beijing Shijitan Hospital diagnosed between July 2006 and October 2010. With the consent of family members of the patients, they were divided into two groups: group A, in whom only vasoactive drugs were used (dopamine + norepinephrine treatment, n = 39), and group B, in whom vasoactive drugs were used combined with IABP (dopamine + norepinephrine + IABP therapy, n = 39). Before and after treatment of two groups, hemodynamic and tissue perfusion monitoring were executed. At the same time, the shock recovery time, the doses of vasoactive drugs, length of ICU stay, and mortality within 28 days were observed.

RESULTS

There was no significant difference in all above parameters between two groups. After treatment, heart rate, blood pressure and heart function parameters were significantly improved compared with those before treatment. In group B, mean arterial pressure (MAP, mm Hg,1 mm Hg = 0.133 kPa) 24 hours and 72 hours after IABP, cardiac index [CI, L×min(-1)× m(-2)] after 48 hours of IABP, and in 2 hours after termination of IABP, dopamine dosage [μg×kg(-1)×min(-1)] in 24, 48, 72 hours after IABP and 2 hours after termination were significantly improved than those in group A (MAP: 53.0 ± 6.3 vs. 52.1 ± 6.2, 65.6 ± 4.3 vs. 65.0 ± 2.1; CI: 3.40 ± 0.20 vs. 3.30 ± 0.50, 3.60 ± 0.30 vs. 3.60 ± 0.30; dopamine dosage: 17.5 ± 1.2 vs. 17.6 ± 1.3, 10.2 ± 1.3 vs. 12.8 ± 1.6, 5.8 ± 1.5 vs. 6.8 ± 1.7, 3.0 ± 0.7 vs. 4.1 ± 1.3, P < 0.05 or P < 0.01). Compared with group A, shock recovery time (days) of group B was significantly shorter (10.4 ± 2.2 vs. 14.1 ± 3.4, P < 0.01) than that of group A; mortality within 28 days was significantly lower (34.1% vs. 45.6%, P < 0.01) in group B; length of ICU stay of two groups showed no significant difference between two groups.

CONCLUSIONS

IABP in patients with septic shock significantly improved hemodynamics, increased coronary and systemic tissue perfusion, reduced cardiac afterload, elevated CI, reduced doses of vasoactive drugs, shortened length of ICU stay, improved prognosis, and lowered the mortality rate. IABP had important clinical value, and could be recommended as an additional treatment option in patients with septic shock in whom the effect of drug was poor.