title: Is myocardial adrenergic responsiveness depressed in human septic shock?
abstract: OBJECTIVE
  To assess left ventricular (LV) contractile function and adrenergic responsiveness in septic patients.
  
  
  METHODS
  We used echocardiographically defined fractional area of contraction (FAC), and LV area to end-systolic arterial pressure estimates of end-systolic elastance (E'es) and its change in response to dobutamine (5 microg/kg/min) in 10 subjects in septic shock admitted to an intensive care unit of an academic medical center. Subjects were studied on admission and again at both 5 days and 8-10 days after admission.
  
  
  RESULTS
  Three of the 10 subjects died as a result of their acute process, while the others were discharged from hospital. Nine out of 10 subjects required intravenous vasopressor therapy on day 1, while only 1 of 9 subjects required vasopressor support at day 5. LV end-diastolic area (EDA) increased from day 1 to day 5 and days 8-10 (p<0.05), but neither FAC nor E'es was altered by time (EDA 15.7+/-5.8, 21.4+/-5.1, and 19.4+/-5.6 cm2; FAC 0.46+/-0.19, 0.50+/-0.20, and 0.48+/-0.15%; E'es 21.6+/-12.6, 23.2+/-8.5, and 19.2+/-6.3 mmHg/cm2, mean+/-SD, for days 1, 5 and 8-10 respectively). Although dobutamine did not alter E'es on day 1 or day 5, E'es increased in all of the 5 subjects studied on days 8-10 (p<0.05).
  
  
  CONCLUSIONS
  Adrenergic hyporesponsiveness is present in septic shock and persists for at least 5 days into recovery, resolving by days 8-10 in survivors.
authors.affiliation: Cochin-Saint Vincent de Paul Hospital and Paris Descartes University, Paris, France.
authors.forename: Alain
authors.initials: A
authors.lastname: Cariou
authors.forename: Michael R
authors.initials: MR
authors.lastname: Pinsky
authors.forename: Mehran
authors.initials: M
authors.lastname: Monchi
authors.forename: Ivan
authors.initials: I
authors.lastname: Laurent
authors.forename: Christophe
authors.initials: C
authors.lastname: Vinsonneau
authors.forename: Jean-Daniel
authors.initials: JD
authors.lastname: Chiche
authors.forename: Julien
authors.initials: J
authors.lastname: Charpentier
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Dhainaut
mesh_terms: D000318:Adrenergic beta-Agonists / Q000494:pharmacology*; D000328:Adult; D000368:Aged; D004280:Dobutamine / Q000494:pharmacology*; D004452:Echocardiography; D004548:Elasticity / Q000187:drug effects; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009200:Myocardial Contraction / Q000187:drug effects*; D009599:Nitroprusside; D012772:Shock, Septic / Q000150:complications / Q000503:physiopathology*; D014665:Vasodilator Agents; D018487:Ventricular Dysfunction, Left / Q000209:etiology / Q000503:physiopathology*
chemical_list: D000318:Adrenergic beta-Agonists; D014665:Vasodilator Agents; D009599:Nitroprusside; D004280:Dobutamine