Persistent Preload Defect in Severe Sepsis Despite Fluid Loading: Results

18 Sep
2014

Due to 63% feasibility of transthoracic echocardiography, 90 of the 144 patients with severe sepsis hospitalized over a 5-year period were qualified for our study and underwent serial echocardiographic evaluation. Of these, only 34 recovered and were discharged from our ICU (group I). Fifty-six patients died, resulting in an overall mortality of 62% (group II). Among the 54 patients who were not included because of inadequate echocardiographic imaging, only 20 recovered, yielding a similar mortality rate (64%).
The average duration of the monitoring period was 4.4 ± 1.6 days, and was significantly shorter in group I than in group II (3.2 ± 0.6 days vs 5.1 ± 2.0 days, respectively). During this period, 28 patients of group II (50%) died from refractory circulatory failure associated with ARDS (1 patient) or multiple organ dysfunction syndrome (27 patients). The remaining patients of group II (50%) died later from ARDS (16 patients) or recurrent circulatory failure with multiple organ dysfunction syndrome (12 patients).
The main clinical findings (SAPS II, blood lactate level, Pa02/Fl02, causative bacterial agents, amount of fluid used for resuscitation) are presented in Table 1. General severity, as assessed by SAPS II, was more marked in group II. There was a prevalence of Gram-positive (60%) vs Gram-negative bacteria (40%). There was no significant difference between groups in this distribution. The total amount of fluid used for resuscitation did not differ significantly between the groups, but the proportion of colloids required was three times greater in group II. yaz birth control

Echographic measurement in the control group established a normal value for LVEDV of 68.5 ± 14.7 mL/m2 and for LVEF of 69.1 ± 6.1%, resulting in an LVSV of 47.0 ± 9.9 mL/m2, with a mean heart rate of 71 ± 9 beats/min. The main echocardiographic data in septic patients are presented in Table 2. The mean heart rate was significantly elevated in both groups when compared with the value in the control group or in group I at recovery, and tachycardia persisted during the monitoring period. At day 1, LVEDV was 75.3 ± 20.1 mL/m2 and 64.9 ± 25.0 mL/m2 in groups I and II, respectively, remaining within the normal range. However, LVEDV was significantly smaller in group II than in group I.

Table 1—Characteristics of Treatment Groups

CharacteristicsGroup I(n = 34)Group II(n = 56)
Mean age, yr55 ± 1855 ± 19
SAPS II51.7 ± 18.868.1 ± 21t
Blood lactate level, mmol/L8 ± 3.56.1 ± 2.7
Pa0£/Fi02153.5 ± 64.4149.5 ± 126.9
Fluid total, L/d4.1 ± 0.95.2 ± 1.6
Colloids total, L/d0.5 ± 0.31.5 ± 0.4t
Gram-positive agents{1935

Table 2—Echocardiographic Data

VariablesDay 1Day 2Day nRecovery
HR, beats/min
Gr I111 ± 24{113 ± 22t103 ± 14|82 ± 9
Gr II115 ± 25117 ± 23110 ± 24
LVEDV, mL/m2
Gr I75.3 ± 20.1t80.3 ± 20.9f/t75.4 ± 21.8f70.5 ± 14.7
Gr II64.9 ± 25.062.2 ± 15.260.2 ± 21.6
LVESV, mL/m2
Gr I42.4 ± 17.9ft43.6 ± 15.0f/t35.7 ± 14.9J27.6 ± 10.2
Gr II32.2 ± 17.734.8 ± 16.630.2 ± 16.4
LVSV, mL/m2
Gr I32.6 ± 13.8|36.7 ± 12.1f39.7 ± 12.0f42.9 ± 11.3
Gr II32.7 ± 17.727.4 ± 13.930.0 ± 14.5
LVEF, %
Gr I43.9 ± 16.4f/t41.6 ± 10.6J53.2 ± 11.7|60.2 ± 16.4
Gr II52.0 ± 14.045.7 ± 15.751.0 ± 16.8
top