Catheter-Derived Hemodynamic Studies

Table 1 shows the hemodynamic changes from initial to final study in the 22 survivors and 17 nonsurvivors of septic shock.

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Radionuclide Ventriculography

Based on our previous studies of left ventricular function, four serial radionuclide scans (at shock onset, and at three, seven, and ten days following shock) were planned for each patient. In the present study, at least two radionuclide ventriculography studies were performed on each patient. The first scan was done as near to the onset of shock as technically feasible, always within the first 24 hours. The final study in survivors was done when they were hemodynamically stable and not receiving any vasopressors, usually 6 to 14 days after the onset of shock. The final study in nonsurvivors was done within 24 hours of death.

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Patient Population

Thirty nine patients with septic shock were studied in the Medical Intensive Care Unit at the Clinical Center of the National Institutes of Health, Bethesda, Md. All patients met our clinical definition of septic shock: fever (temperature >38°C), hypotension (mean arterial pressure <60 mm Hg), and positive blood cultures. The mean age of the patients was 45.2 years, with a range of 12 to 73 years. There were 23 male and 16 female patients. Twenty-two patients (56 percent) survived the acute septic shock episode; 17 did not. Underlying diseases included malignant neoplasms in 35 patients and one patient each with chronic hepatitis, Cushing’s syndrome, a-antitrypsin deficiency, and an immunodeficiency of undetermined cause. Sixteen patients had Cram-negative organisms in their blood, 12 had Cram-positive organisms, five had a fungus, and six had mixed infections with more than one organism cultured (two with a Cram-positive organism and fungus; one with a Cram- negative organism and a fungus; one with a Cram-positive and a Gram-negative organism; one with two different Gram-negative organisms; and one with a Gram-positive organism, a Gram-negative organism, and a fungus).

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Septic shock in humans is usually characterized by a hyperdynamic hemodynamic profile. During human septic shock, reversible depression of left ventricular ejection fraction and dilatation of the left ventricle have been described using radionuclide angiography or echocardiography. These changes in left ventricular function and size are transient and return toward normal in survivors at seven to ten days after the onset of septic shock.

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