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Cardiac morphological and functional changes during early septic shock: a transesophageal echocardiographic study
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Cardiac morphological and functional changes during early septic shock: a transesophageal echocardiographic study
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Journal Article
Cardiac morphological and functional changes during early septic shock: a transesophageal echocardiographic study
2008
Overview
Objective
The objective was to prospectively evaluate cardiac morphological and functional changes using transesophageal echocardiography (TEE) during early septic shock.
Design
Prospective, observational study.
Setting
Medical-surgical intensive care unit of a teaching hospital.
Patients and participants
Ventilated patients with septic shock, sinus rhythm and no cardiac disease underwent TEE within 12 h of admission (Day 0), after stabilization of hemodynamics by fluid loading (median volume: 4.9 l [lower and upper quartiles: 3.7–9.6 l]) and vasopressor therapy, and after vasopressors were stopped (Day
n
).
Measurements and results
Thirty-five patients were studied (median age: 60 years [range 44–68]; SAPS II: 53 [46–62]; SOFA score: 9 [8–11]) and 9 of them (26%) died while on vasopressors. None of the patients exhibited TEE findings of cardiac preload dependence. Between Day 0 and Day
n
(7 days [range 6–9]), mean left ventricular (LV) ejection fraction (EF) increased (47 ± 20 vs. 57 ± 14%:
p
< 0.05), whereas mean LV end-diastolic volume decreased (97 ± 25 vs. 75 ± 20 ml:
p
< 0.0001). Out of 16 patients (46%) with LV systolic dysfunction on Day 0, 12 had normal LVEF on Day
n
and 4 patients fully recovered by Day 28. Only 4 women had LV dilatation (range, LV end-diastolic volume: 110–148 ml) on Day 0, but none on Day n. Doppler tissue imaging identified an LV diastolic dysfunction in 7 patients (20%) on Day 0 (3 with normal LVEF), which resolved on Day
n
.
Conclusions
This study confirms that LV systolic and diastolic dysfunctions are frequent, but LV dilatation is uncommon in fluid-loaded septic patients on vasopressors. All abnormalities regressed in survivors, regardless of their severity.
Descriptors
Shock: clinical studies (38), Cardiovascular monitoring (34).
Publisher
Springer-Verlag,Springer,Springer Nature B.V
Subject
/ Adult
/ Aged
/ Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy
/ Biological and medical sciences
/ Echocardiography, Transesophageal
/ Emergency and intensive cardiocirculatory care. Cardiogenic shock. Coronary intensive care
/ Female
/ Humans
/ Male
/ Medicine
/ Original
/ Patients
/ Pneumology/Respiratory System
/ Sepsis
/ Shock, Septic - diagnostic imaging
/ Shock, Septic - physiopathology
