Intensive Care Medicine

, Volume 31, Issue 8, pp 1066–1071 | Cite as

Hemodynamic variables related to outcome in septic shock

  • Marjut Varpula
  • Minna Tallgren
  • Katri Saukkonen
  • Liisa-Maria Voipio-Pulkki
  • Ville Pettilä



To assess the impact of hemodynamic variables on the outcome of critically ill patients in septic shock and to identify the optimal threshold values related to outcome with special reference to continuously monitored mean arterial pressure (MAP) and mixed venous oxygen saturation (SvO2).

Design and setting

Retrospective cohort study in a university hospital intensive care unit (ICU).


All consecutive 111 patients with septic shock treated in our ICU between 1 Jan. 1999 and 30 Jan. 2002.

Measurements and results

The data on the hemodynamic and respiratory monitoring and circulation-related laboratory tests over the first 48 h of treatment in the ICU were collected from the clinical data management system. Data from 6 h and 48 h were analyzed separately. The 30-day mortality rate was 33% (36 of 111). Univariate analysis and forward stepwise logistic regression analysis were performed using the 30-day mortality as the primary endpoint. Mean MAP and lactate on arrival during 6 h, while mean MAP, the area of SvO2 under 70%, and mean CVP during 48 h were independently associated with mortality. MAP level of 65 mmHg and SvO2 of 70% had the highest areas under receiver characteristics curves.


MAP, SvO2, CVP, and initial lactate were independently associated with mortality in septic shock, with threshold values supporting those published in recent guidelines.


Sepsis Septic shock Hemodynamic monitoring Outcome 


  1. 1.
    Dellinger RP, Carlet JM, Masur H, Gerlach H, Calandra T, Cohen J, Gea-Banacloche J, Keh D, Marshall JC, Parker MM, Ramsay G, Zimmerman JL, Vincent J-L, Levy MM (2004) Surviving sepsis campaign guidelines for management of severe sepsis and septic shock. Crit Care Med 32:858–870Google Scholar
  2. 2.
    Dellinger RP (2003) Cardiovascular management of septic shock. Crit Care Med 31:946–955CrossRefPubMedGoogle Scholar
  3. 3.
    Hollenberg SM, Ahrens TS, Annane D, Astiz ME, Chalfin DB, Dasta JF, Heard SO, Martin C, Napolitano LM, Susla GM, Totaro R, Vincent J-L, Zanotti-Cavazzoni S (2004) Practice parameters for hemodynamic support of sepsis in adult patients: 2004 update. Crit Care Med 32:1928–1948Google Scholar
  4. 4.
    Heyes MA, Timmins AC, Yau EH, Palazzo M, Hinds CJ, Watson D (1994) Elevation of systemic oxygen delivery in the treatment of critically ill patients. N Engl J Med 330:1717–1722CrossRefPubMedGoogle Scholar
  5. 5.
    Gattinoni L, Braggi L, Pelosi P, Latini R, Tognoni G, Pesentii A, Fumagalli R (1995) A trial of goal-oriented hemodynamic therapy on critically ill patients. N Engl J Med 333:1026–1031CrossRefGoogle Scholar
  6. 6.
    Yu M, Levy MM, Smith P, Takiguchi SA, Miyasaki A, Myers SA (1993) Effect of maximizing oxygen delivery on morbidity and mortality rates in critically ill patients: a prospective, randomized, controlled study. Crit Care Med 21:830–838PubMedGoogle Scholar
  7. 7.
    Tuchschmidt J, Fried J, Astiz M, Rackow E (1992) Elevation of cardiac output and oxygen delivery improves outcome in septic shock. Chest 102:216–220PubMedGoogle Scholar
  8. 8.
    Alia I, Esteban A, Gordo F, Lorente JA, Diaz C, Rodriguez JA, Frutos F (1999) A randomised and controlled trial of the effect of treatment aimed at maximizing oxygen delivery in patients with severe sepsis or septic shock. Chest 115:453–461CrossRefPubMedGoogle Scholar
  9. 9.
    White WB (1991) Analysis of ambulatory blood pressure data in antihypertensive drug trials. J Hypertension 9:27–32Google Scholar
  10. 10.
    Parker MM, Shelhamer JH, Natanson C, Alling DW, Parrillo JE (1987) Serial cardiovascular variables in survivors and non survivors of human septic shock: heart rate as an early predictor of prognosis. Crit Care Med 15:923–929PubMedGoogle Scholar
  11. 11.
    Tuchschmidt J, Fried J, Swinney R, Sharma OP (1989) Early hemodynamic correlates of survival in patients with septic shock. Crit Care Med 17:719–723PubMedGoogle Scholar
  12. 12.
    Bakker J, Gris P, Coffernils M, Kahn RJ, Vincent J-L (1996) Serial blood lactate levels can predict the development of multiple organ failure following septic shock. Am J Surg 171:221–226CrossRefPubMedGoogle Scholar
  13. 13.
    Vincent J-L, Bruzzi de Carvalho F, De Backer D (2002) Management of septic shock. Ann Med 34:606–613CrossRefPubMedGoogle Scholar
  14. 14.
    Reinhart K, Sakka SG, Meier-Hellmann A (2000) Haemodynamic management of a patient with septic shock. Eur J Anaesthesiol 17:6–17CrossRefPubMedGoogle Scholar
  15. 15.
    Task force of the American College of Critical Care Medicine, Society of Critical Care Medicine (1999) Practice parameters for hemodynamic support of sepsis in adult patients in sepsis. Crit Care Med 23:639–660Google Scholar
  16. 16.
    Patton HD, Fuchs AF, Hille B, Sacher AM, Steiner R (1989) Textbook of physiology. Saunders, PhiladelphiaGoogle Scholar
  17. 17.
    LeDoux D, Astiz ME, Carpati CM, Rackow EC (2000) Effects of perfusion pressure on tissue perfusion in septic shock. Crit Care Med 28:2729–2732CrossRefPubMedGoogle Scholar
  18. 18.
    Rivers E, Nguyen B, Havstad S, Ressler J, Muzzin A, Knoblich B, Peterson E, Tomlanovich M (2001) Early goal-directed therapy in the treatment of severe sepsis and septic shock. N Engl J Med 435:1368–1377CrossRefGoogle Scholar
  19. 19.
    Polonen P, Ruokonen E, Hippelainen M, Poyhonen M, Takala J (2000) A prospective, randomized study of goal oriented hemodynamic therapy in cardiac surgical patients. Anesth Analg 90:1052–1059Google Scholar
  20. 20.
    Ziegler D, Wright J, Choban P, Flancbaum L (1997) A prospective trial of preoperative optimisation of cardiac function in patients undergoing elective peripheral vascular surgery. Surgery 122:584–592CrossRefPubMedGoogle Scholar
  21. 21.
    Nguyen B, Rivers E, Knoblich B, Jacobsen G, Muzzin A, Ressler J, Tomlanovich M (2004) Early lactate clearance is associated with improved outcome in severe sepsis and septic shock. Crit Care Med 32:1637–1642Google Scholar

Copyright information

© Springer-Verlag 2005

Authors and Affiliations

  • Marjut Varpula
    • 1
  • Minna Tallgren
    • 2
  • Katri Saukkonen
    • 1
  • Liisa-Maria Voipio-Pulkki
    • 1
  • Ville Pettilä
    • 2
  1. 1.Emergency WardDepartment of MedicineHelsinkiFinland
  2. 2.Intensive Care Unit, Division of Anesthesiology and Intensive Care MedicineDepartment of SurgeryHelsinkiFinland

Personalised recommendations