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Autonomic control of the heart and peripheral vessels in human septic shock

Abstract

Objective

Circulating endotoxin impairs the sympathetic regulation of the cardiovascular system in animals. We studied the changes in the autonomic control of the heart and circulation during septic shock in humans.

Design

12 patients (age 43.0±6, 17–83 years) were investigated during septic shock (mean duration: 3.5±0.5 days) and during recovery, fluctuations in R-R interval, invasive arterial pressure (AP) and peripheral arteriolar circulation (PC, photoplethysmography) were evaluated by spectral analysis as a validated nonivasive measure of sympathovagal tone. Apache II score was adopted as the disease severity index. Low frequency components (0.03–0.15 Hz) of the frequency spectra were expressed as relative to the overall variability (LFnu) for each cardiovascular variable.

Results

LFnu were low or absent during shock but, in the 10 patients who recovered, increased by the time of discharge (post-shock). R-R LFnu increased from 17±6 to 47±9 (p<0.03), AP LFnu from 6±3 to 35±4 (p<0.02) and PC LFnu from 18±3 to 66±4 (p<0.001). Apache II fell from 23.1±1, at admission, to 14.8±1.8 at discharge (p<0.005). Two patients died showing no LFnu increase.

Conclusion

Reduced LF components of the variability of cardiovascular signals are characteristic of septic shock, confirming the presence of abnormal autonomic control. Restored sympathetic (LF) modulation seems to be associated with a favourable prognosis.

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Correspondence to M. Piepoli.

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Piepoli, M., Garrard, C.S., Kontoyannis, D.A. et al. Autonomic control of the heart and peripheral vessels in human septic shock. Intensive Care Med 21, 112–119 (1995). https://doi.org/10.1007/BF01726532

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Key words

  • Autonomic nervous system
  • Sepsis syndrome
  • Peripheral circulation
  • Heart rate variability
  • Blood pressure variability
  • Spectral analysis
  • Adrenergic receptors
  • Intensive care