title: Early preload adaptation in septic shock? A transesophageal echocardiographic study.
abstract: BACKGROUND
  An accepted concept in septic shock is that preload adaptation by acute left ventricular dilatation, when occurring spontaneously or with the aid of volume loading, permits maintenance of an adequate cardiac output, leading to final recovery. From a physiologic point of view, this concept appears debatable because a normal pericardium exerts a restraining action on a normal heart.
  
  
  METHODS
  During a 26-month period, the authors investigated, by transesophageal echocardiography, 40 patients hospitalized in their unit for an episode of septic shock. Transesophageal echocardiography was performed in the first hours after admission, proceeded by correction of any hypovolemia, and stabilization of arterial pressure by vasoactive agent infusion if necessary. Left ventricular dimensions were obtained in long- and short-axis views, permitting calculation of left ventricular ejection fraction (long axis) and fractional area contraction (short axis). Stroke index was simultaneously measured by the Doppler technique.
  
  
  RESULTS
  Stroke index was strongly correlated with both echocardiographic left ventricle ejection fraction (r = 0.75; P < 0.0001) and left ventricle fractional area contraction (r = 0.76; P < 0.0001), whereas it was independent of echocardiographic left ventricle diastolic dimensions.
  
  
  CONCLUSIONS
  The transesophageal echocardiography study was unable to confirm the reality of the concept of early preload adaptation by left ventricular dilatation in septic shock. Conversely, because left ventricular volume always remained in a normal range after correcting hypovolemia, systolic function was the unique determinant of stroke index in septic shock.
authors.affiliation: Medical Intensive Care Unit, University Hospital Ambroise Paré, Boulogne, France.
authors.forename: A
authors.initials: A
authors.lastname: Vieillard Baron
authors.forename: J M
authors.initials: JM
authors.lastname: Schmitt
authors.forename: A
authors.initials: A
authors.lastname: Beauchet
authors.forename: R
authors.initials: R
authors.lastname: Augarde
authors.forename: S
authors.initials: S
authors.lastname: Prin
authors.forename: B
authors.initials: B
authors.lastname: Page
authors.forename: F
authors.initials: F
authors.lastname: Jardin
mesh_terms: D000328:Adult; D017548:Echocardiography, Transesophageal; D005260:Female; D005440:Fluid Therapy; D006439:Hemodynamics; D006801:Humans; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D012121:Respiration, Artificial; D012772:Shock, Septic / Q000503:physiopathology* / Q000628:therapy; D013566:Sympathomimetics / Q000627:therapeutic use
chemical_list: D013566:Sympathomimetics