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Cardiac morphological and functional changes during early septic shock: a transesophageal echocardiographic study

Caroline Etchecopar-Chevreuil| Bruno François| Marc Clavel| Nicolas Pichon| Hervé Gastinne| Philippe Vignon
Original
Volume 34, Issue 2 / February , 2008

Pages 250 - 256

Abstract

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).

Keywords

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