Cardiac morphological and functional changes during early septic shock: a transesophageal echocardiographic study.
OBJECTIVE
The objective was to prospectively evaluate cardiac morphological and functional changes using transesophageal echocardiography (TEE) during early septic shock.


METHODS
Prospective, observational study.


METHODS
Medical-surgical intensive care unit of a teaching hospital.


METHODS
Ventilated patients with septic shock, sinus rhythm and no cardiac disease underwent TEE within 12h of admission (Day0), after stabilization of hemodynamics by fluid loading (median volume: 4.9l [lower and upper quartiles: 3.7-9.6l]) and vasopressor therapy, and after vasopressors were stopped (Dayn).


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 Day0 and Dayn (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 +/- 20ml: p < 0.0001). Out of 16 patients (46%) with LV systolic dysfunction on Day0, 12 had normal LVEF on Dayn and 4 patients fully recovered by Day28. Only 4 women had LV dilatation (range, LV end-diastolic volume: 110-148ml) on Day0, but none on Dayn. Doppler tissue imaging identified an LV diastolic dysfunction in 7 patients (20%) on Day0 (3 with normal LVEF), which resolved on Dayn.


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.


BACKGROUND
Shock: clinical studies (38), Cardiovascular monitoring (34).
Etchecopar-Chevreuil
Caroline
C
Dupuytren Teaching Hospital, Medical-Surgical Intensive Care Unit, 2 Avenue Martin Luther King, 87042 Limoges Cedex, France.
François
Bruno
B
Clavel
Marc
M
Pichon
Nicolas
N
Gastinne
Hervé
H
Vignon
Philippe
P
D000328:Adult; D000368:Aged; D017548:Echocardiography, Transesophageal; D005260:Female; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012151:Resuscitation / Q000379:methods; D012772:Shock, Septic / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D018709:Statistics, Nonparametric; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging* / Q000503:physiopathology*