The native cardiac output in human sepsis: a systematic review.
BACKGROUND
The cardiac output (CO) response to sepsis is typically measured in the intensive care unit after modification by fluid and/or vasoactive drug resuscitation and found to be hyperdynamic. In contrast, the native (preresuscitation) CO in human sepsis is poorly defined.


METHODS
Systematic literature review of studies reporting the cardiac index (CI) of patients with sepsis before resuscitation, using searches of PubMed, MEDLINE and Embase.


RESULTS
We identified 5667 citations from 1929 to 2014. Of 179 articles meeting inclusion criteria, only four studies reported CO measurements before any treatment, in a total of 181 patients. Only two of the four studies reported age distribution (mean age, 72 years) for a total of 159 patients. We calculated the mean CI in these four studies to be 2.68 L/ min/m(2) (SD, 0.42 L/min/m(2); median, 2.52 L/min/m(2); range, 2.36-3.3 L/min/m(2)). Only one study presented mixed venous oxygen saturation data as an estimate of the adequacy of perfusion, and in three studies there was evidence of reduced cardiac performance.


CONCLUSIONS
Data about the native CO in human sepsis are scant because therapeutic intervention usually precedes measurement. From the limited data available, it appears that most patients are in a normodynamic haemodynamic state at presentation, and cardiac performance also seems to be impaired at the earliest stage of sepsis. As initial resuscitation is partly predicated on assumptions about the underlying cardiovascular physiology, our findings suggest the need to address this knowledge deficit in the management of patients with severe sepsis.
Department of Intensive Care, Austin Hospital, Melbourne, VIC, Australia. andrew.hilton@austin.org.au.
Luca
L
Cioccari
Department of Intensive Care, Austin Hospital, Melbourne, VIC, Australia.
Nora
N
Luethi
Department of Intensive Care, Austin Hospital, Melbourne, VIC, Australia.
Ulrike
U
Weber
Department of Intensive Care, Austin Hospital, Melbourne, VIC, Australia.
Andrew
A
Hilton
Department of Intensive Care Medicine, Bern University Hospital (Inselspital) and University of Bern, Bern, Switzerland.
Jukka
J
Takala
Department of Intensive Care, Austin Hospital, Melbourne, VIC, Australia.
Rinaldo
R
Bellomo
D002302:Cardiac Output / Q000502:physiology*; D006801:Humans; D018805:Sepsis / Q000503:physiopathology*