To compare the resuscitation effect and prognosis of patients with septic shock between using conventional hemodynamic index-oriented fluid resuscitation and using peripheral perfusion index (PPi)-oriented fluid resuscitation guided by conventional hemodynamic indexes, and to investigate the clinical value of using PPi to guide fluid resuscitation.

From October 2018 to June 2020, 40 adult patients with septic shock admitted to the Department of Critical Care Medicine of the Affiliated Hospital of Hangzhou Normal University were divided into a conventional group and an observation group (PPi < 1.4), with 20 cases in each group. All enrolled patients were monitored for pulse-indicated continuous cardiac output and PPi. Patients in both groups were treated according to clinical guidelines. Patients in the conventional group should achieve the following hemodynamic goals to terminate fluid resuscitation: central venous pressure 8 ~ 12 mmHg, urine output > 0.5 mL·kg^-1·h^-1, central venous oxygen saturation (ScvO₂) ≥ 70% and mean arterial pressure ≥ 65 mmHg. On the basis of achieving the above goals, patients in the observation group continued fluid resuscitation by the 2-5 rule with PPi < 1.4, and vasoactive drugs were adjusted to increase the mean arterial pressure until the target PPi ≥ 1.4 if it was not suitable to continue fluid replacement. The general information, the acute physiology and chronic health evaluation Ⅱ (APACHEⅡ) score after 0 and 6 h of resuscitation, and the heart rate, mean arterial pressure, cardiac output, ScvO₂, venous-to-arterial carbon dioxide difference (Pcv-aCO₂) and blood lactate after 0, 6, 24 and 48 h of resuscitation were recorded. The lactate clearance rate and ICU mortality rate at 6 and 24 h of resuscitation were calculated.

Before and after the two goal-oriented fluid resuscitation methods, there were no significant differences in the heart rate, mean arterial pressure, cardiac output, ScvO₂ and Pcv-aCO₂ at 0, 6, 24, and 48 h between the two groups (F = 0.197, 0.070, 2.658, 2.424, 1.687; P = 0.846, 0.958, 0.080, 0.119, 0.182), while the difference in blood lactate levels was statistically significant (F = 18.792, P < 0.001). Further pairwise comparison showed that the blood lactate levels at 6 and 24 h in the observation group were lower than those in the conventional group, and the lactate clearance rates at 6 and 24 h were higher (all P < 0.05). After 6 h of resuscitation, the APACHEⅡ score in the observation group was significantly lower than that in the conventional group [(21 ± 4) vs. (25 ± 5), t = 2.450, P = 0.019]. In addition, although the ICU deaths in the observation group were fewer than those in the conventional group, there was no significant difference in ICU mortality between the two groups (5/20 vs. 7/20, χ² = 0.476, P = 0.490).

Fluid resuscitation can improve the hemodynamic status of patients with septic shock, and the fluid resuscitation guided by conventional hemodynamic indexes combined with PPi can effectively reduce blood lactate, accelerate blood lactate clearance and decrease APACHEⅡ, which is expected to improve prognosis.