title: Actual incidence of global left ventricular hypokinesia in adult septic shock.
abstract: OBJECTIVE
  To evaluate the actual incidence of global left ventricular hypokinesia in septic shock.
  
  
  METHODS
  All mechanically ventilated patients treated for an episode of septic shock in our unit were studied by transesophageal echocardiography, at least once a day, during the first 3 days of hemodynamic support. In patients who recovered, echocardiography was repeated after weaning from vasoactive agents. Main measurements were obtained from the software of the apparatus. Global left ventricular hypokinesia was defined as a left ventricular ejection fraction of <45%.
  
  
  RESULTS
  During a 3-yr period (January 2004 through December 2006), 67 patients free from previous cardiac disease, and who survived for >48 hrs, were repeatedly studied. Global left ventricular hypokinesia was observed in 26 of these 67 patients at admission (primary hypokinesia) and in 14 after 24 or 48 hrs of hemodynamic support by norepinephrine (secondary hypokinesia), leading to an overall hypokinesia rate of 60%. Left ventricular hypokinesia was partially corrected by dobutamine, added to a reduced dosage of norepinephrine, or by epinephrine. This reversible acute left ventricular dysfunction was not associated with a worse prognosis.
  
  
  CONCLUSIONS
  Global left ventricular hypokinesia is very frequent in adult septic shock and could be unmasked, in some patients, by norepinephrine treatment. Left ventricular hypokinesia is usually corrected by addition of an inotropic agent to the hemodynamic support.
authors.affiliation: Medical Intensive Care Unit, University Hospital Ambroise Paré, Assistance Publique Hôpitaux de Paris, Boulogne Cedex, France.
authors.forename: Antoine
authors.initials: A
authors.lastname: Vieillard-Baron
authors.forename: Vincent
authors.initials: V
authors.lastname: Caille
authors.forename: Cyril
authors.initials: C
authors.lastname: Charron
authors.forename: Guillaume
authors.initials: G
authors.lastname: Belliard
authors.forename: Bernard
authors.initials: B
authors.lastname: Page
authors.forename: François
authors.initials: F
authors.lastname: Jardin
mesh_terms: D018806:APACHE; D000328:Adult; D000368:Aged; D002303:Cardiac Output, Low / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000453:epidemiology* / Q000401:mortality; D002316:Cardiotonic Agents / Q000627:therapeutic use; D003422:Critical Care; D003430:Cross-Sectional Studies; D004280:Dobutamine / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D017548:Echocardiography, Transesophageal / Q000187:drug effects; D004837:Epinephrine / Q000627:therapeutic use; D005260:Female; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009638:Norepinephrine / Q000627:therapeutic use; D011446:Prospective Studies; D012121:Respiration, Artificial; D015996:Survival Rate; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000453:epidemiology* / Q000401:mortality; D018497:Ventricular Dysfunction, Right / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000453:epidemiology / Q000401:mortality
chemical_list: D002316:Cardiotonic Agents; D004280:Dobutamine; D009638:Norepinephrine; D004837:Epinephrine