Persistent Preload Defect in Severe Sepsis Despite Fluid Loading: Echocardiographic data

19 Sep
2014

Persistent Preload Defect in Severe Sepsis Despite Fluid Loading: Echocardiographic dataAt day n, LVEDV was 75.4 ± 21.8 mL/m2 and 60.2 ± 21.6 mL/m2 in groups I and II, respectively, still within the normal range. However, LVEDV in group II tended to decrease and remained significantly smaller than in group I. At day 1, LVEF was 43.9 ± 16.4% and 52 ± 14% in groups I and II, respectively, and significantly lower than in the control group. Moreover, LVEF was significantly more reduced in group I than in group II. In group I at day 1, nine patients (27%) had severe hypokinesia with LVEF < 30%, whereas the same finding was only noted in five patients (8%) in group II (p < 0.05). At day n, LVEF was 53.2 ± 11.7% and 51 ± 16.8% in groups I and II, respectively, and no significant between-group difference persisted. During the monitoring period, although LVEF significantly increased in group I, it remained significantly lower than in the control group and returned to normal (60.2 ± 16.4%) at discharge. At day 1, LVSV was significantly smaller in both groups I and II (32.6 ± 13.8 mL/m2 and 32.7 ± 15.1 mL/m2, respectively) than in the control group. During the monitoring period, LVSV significantly increased in group I but remained unchanged in group II. review

Echocardiographic data recorded for gram-positive and gram-negative sepsis did not differ significantly.
Discussion
Septic shock is considered as a “hyperdynamic” or “hyperkinetic” state. This concept, which was derived from experimental data using animal models acutely infected by gram-negative agents, might differ somewhat from human septic shock. The hyperkinetic concept has been corroborated in the past by clinical studies reporting that cardiac output was either normal or increased.- But most of these studies were performed in patients submitted to aggressive fluid loading. Our echocardiographic data suggest that the term “hyperkinetic” is not appropriate to describe a setting in which the left ventricle was always hypokinetic, sometimes so severely that it looked as if it was “stunned.”

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