Hemodynamic variables related to outcome in septic shock
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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.
KeywordsSepsis Septic shock Hemodynamic monitoring Outcome
- 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
- 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
- 9.White WB (1991) Analysis of ambulatory blood pressure data in antihypertensive drug trials. J Hypertension 9:27–32Google Scholar
- 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.Patton HD, Fuchs AF, Hille B, Sacher AM, Steiner R (1989) Textbook of physiology. Saunders, PhiladelphiaGoogle Scholar
- 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
- 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