Abstract
Objective
To assess left ventricular (LV) contractile function and adrenergic responsiveness in septic patients.
Methods
We used echocardiographically defined fractional area of contraction (FAC), and LV area to end-systolic arterial pressure estimates of end-systolic elastance (E'es) and its change in response to dobutamine (5 μg/kg/min) in 10 subjects in septic shock admitted to an intensive care unit of an academic medical center. Subjects were studied on admission and again at both 5 days and 8–10 days after admission.
Results
Three of the 10 subjects died as a result of their acute process, while the others were discharged from hospital. Nine out of 10 subjects required intravenous vasopressor therapy on day 1, while only 1 of 9 subjects required vasopressor support at day 5. LV end-diastolic area (EDA) increased from day 1 to day 5 and days 8–10 (p < 0.05), but neither FAC nor E'es was altered by time (EDA 15.7 ± 5.8, 21.4 ± 5.1, and 19.4 ± 5.6 cm2; FAC 0.46 ± 0.19, 0.50 ± 0.20, and 0.48 ± 0.15%; E'es 21.6 ± 12.6, 23.2 ± 8.5, and 19.2 ± 6.3 mmHg/cm2, mean ± SD, for days 1, 5 and 8–10 respectively). Although dobutamine did not alter E'es on day 1 or day 5, E'es increased in all of the 5 subjects studied on days 8–10 (p < 0.05).
Conclusions
Adrenergic hyporesponsiveness is present in septic shock and persists for at least 5 days into recovery, resolving by days 8–10 in survivors.
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Dr. Pinsky was a Professeur Associé at Cochin Hospital and Paris Descartes University.
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Cariou, A., Pinsky, M.R., Monchi, M. et al. Is myocardial adrenergic responsiveness depressed in human septic shock?. Intensive Care Med 34, 917–922 (2008). https://doi.org/10.1007/s00134-008-1022-y
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DOI: https://doi.org/10.1007/s00134-008-1022-y