Persistent Preload Defect in Severe Sepsis Despite Fluid Loading

15 Sep

Persistent Preload Defect in Severe Sepsis Despite Fluid LoadingA Longitudinal Echocardiographic Study in Patients With Septic Shock
In patients with an episode of septic shock, abnor mal vascular tone was reported by Siegel et al in 1967 and has since been considered as the major hemodynamic consequence of sepsis.2 More recently, some depression of left ventricular (LV) systolic function was recognized, but its meaning and clinical importance remain controversial. Furthermore, in the most severe patients, LV myocardial depression is associated with preload impairment, and experts agree that fluid challenge plays an important part in hemodynamic support. canadian health&care mall

The present study was devoted to a longitudinal description of the changes in echocardiographic LV function during resuscitation of septic patients, with particular attention to changes in LV systolic function, as reflected by the course of left ventricular ejection fraction (LVEF) and in preload preservation, derived from the course of left ventricular end-diastolic volume (LVEDV).
Materials and Methods

From January 1989 to December 1993, 90 of 144 adult patients admitted to our medical ICU for an episode of septic shock yielded high-quality echocardiographic visualization of the LV endocardium (transthoracic approach), thereby allowing reliable measurements of LV cavity dimensions at end-diastole (LVEDV) and end-systole (left ventricular end-systolic volume [LVESV]). These 90 patients (52 men and 38 women, mean age, 55 ± 18 years) were predominantly medical (77 medical vs 13 surgical patients) and were assigned to a longitudinal echocardiographic study. Prerequisites for entry of patients into this study were as follows: (1) hemodynamic support with a vasoactive agent for > 24 h; (2) absence of prior cardiopulmonary disease; and (3) identification of the causative bacterial agent. Positive blood cultures were obtained in 77 patients, and a bacterial species was isolated from a localized site of infection in 13 additional patients. In all patients, only the first episode of septic shock was considered, and measurements performed during a recurrent episode were not used in the study.