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Critical Care

, 18:R80

First Online: 24 April 2014Received: 23 November 2013Accepted: 03 April 2014

Abstract

IntroductionSeptic shock is the most severe manifestation of sepsis. It is characterized as a hypotensive cardiovascular state associated with multiorgan dysfunction and metabolic disturbances. Management of septic shock is targeted at preserving adequate organ perfusion pressure without precipitating pulmonary edema or massive volume overload. Cardiac dysfunction often occurs in septic shock patients and can significantly affect outcomes. One physiologic approach to detect the interaction between the heart and the circulation when both are affected is to examine ventriculoarterial coupling, which is defined by the ratio of arterial elastance Ea to left ventricular end-systolic elastance Ees. In this study, we analyzed ventriculoarterial coupling in a cohort of patients admitted to ICUs who presented with vs without septic shock.

MethodsIn this retrospective cross-sectional opportunity study, we measured routine hemodynamics using indwelling arterial and pulmonary arterial catheters and transthoracic echocardiograms in 25 septic patients group S and 25 non–septic shock patients group C upon ICU admission. Ees was measured by echocardiography using a single-beat EesSB method. Ea was calculated as 0.9 systolic arterial pressure-stroke volume, and then the Ea-EesSB ratio was calculated normal value <1.36.

ResultsIn group S, 21 patients had an Ea-EesSB ratio >1.36 uncoupled. The four patients with Ea-EesSB ratios ≤1.36 had higher EesSB values than patients with Ea-EesSB ratios >1.36 P = 0.007, although Ea measurements were similar in both groups P = 0.4. In group C, five patients had uncoupled Ea-EesSB ratios. No correlation was found between EesSB and left ventricular ejection fraction and between Ea-EesSB ratio and mixed venous oxygen saturation in septic shock patients.

ConclusionsUpon admission to the ICU, patients in septic shock often display significant ventriculoarterial decoupling that is associated with impaired left ventricular performance. Because Ea-Ees decoupling alters cardiovascular efficiency and cardiac energetic requirements independently of Ea or Ees, we speculate that septic patients with ventriculoarterial uncoupling may benefit from therapy aimed at normalizing the Ea-Ees ratio.

AbbreviationsCICardiac index

COCardiac output

EaArterial elastance

EesSBESSingle-beat end-systolic left ventricular elastance

EesEnd-systolic left ventricular elastance

EFEjection fraction

ESPEnd-systolic pressure

ESPVREnd systolic pressure–volume relationship

HRHeart rate

LVLeft ventricular

MAPMean arterial pressure

PpaoPulmonary artery occlusion pressure

ScVO2Central venous oxygen saturation

SVStroke volume

SvO2Mixed venous oxygen saturation.

Electronic supplementary materialThe online version of this article doi:10.1186-cc13842 contains supplementary material, which is available to authorized users.

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Author: Fabio Guarracino - Baldassare Ferro - Andrea Morelli - Pietro Bertini - Rubia Baldassarri - Michael R Pinsky

Source: https://link.springer.com/







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