Accuracy in early prediction of prognosis of patients with septic shock by analysis of simple indices: prospective study.
In 26 consecutive septic shock patients, we analyzed the clinical, hemodynamic, and metabolic data before and during volume infusion to test their circulatory reserve in response to fluid repletion. These patients were investigated to identify early variables that could predict outcome. There were 15 survivors (group A) and 11 nonsurvivors (group B). As a mean, group A patients were hemodynamically evaluated 2.3 h after onset of the sepsis syndrome, whereas group B patients underwent cardiac catheterization after a 12-h interval. At the initial evaluation, both groups demonstrated similarly decreased mean arterial pressure, mean heart rate, and mean cardiac filling pressure. Only group A patients evidenced elevated cardiac index (CI) (greater than 4 L/min.m2) associated with low systemic vascular resistance index (less than 7400 dyne.sec/cm5.m2), which is generally recognized as hyperdynamic cardiac state. However, none of the initial cardiovascular variables could serve as a predictor for survival. Fluid challenge increased left ventricular preload from 6 to 12.4 and from 7.8 to 12.7 mm Hg in group A and group B, respectively. The increases were associated with significant increases in CI from 4.4 to 6.9 and from 3 to 3.8 L/min.m2. However, at the end of fluid challenge, only group A patients exhibited normal cardiac response, as evidenced by the change in left ventricular stroke work index (LVSWI) for a given increase in the pulmonary capillary wedge pressure (WP) that was referred to as left cardiac preload.(ABSTRACT TRUNCATED AT 250 WORDS)
D'Orio
V
V
Hôpital Universitaire du Sart Tilman, Unité Soins Intensifs Médicaux, Liege, Belgium.
Mendes
P
P
Saad
G
G
Marcelle
R
R
D000328:Adult; D000368:Aged; D006328:Cardiac Catheterization / Q000592:standards; D005069:Evaluation Studies as Topic; D005440:Fluid Therapy / Q000592:standards*; D006439:Hemodynamics; D006801:Humans; D007362:Intensive Care Units; D008875:Middle Aged; D010101:Oxygen Consumption; D010343:Patient Admission; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D012772:Shock, Septic / Q000378:metabolism / Q000401:mortality* / Q000503:physiopathology; D016019:Survival Analysis; D015996:Survival Rate