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Is myocardial adrenergic responsiveness depressed in human septic shock?

Cariou, A and Pinsky, MR and Monchi, M and Laurent, I and Vinsonneau, C and Chiche, JD and Charpentier, J and Dhainaut, JF (2008) Is myocardial adrenergic responsiveness depressed in human septic shock? Intensive Care Medicine, 34 (5). 917 - 922. ISSN 0342-4642

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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. © 2008 Springer-Verlag.


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Details

Item Type: Article
Status: Published
Creators/Authors:
CreatorsEmailPitt UsernameORCID
Cariou, A
Pinsky, MRpinsky@pitt.eduPINSKY
Monchi, M
Laurent, I
Vinsonneau, C
Chiche, JD
Charpentier, J
Dhainaut, JF
Date: 1 May 2008
Date Type: Publication
Journal or Publication Title: Intensive Care Medicine
Volume: 34
Number: 5
Page Range: 917 - 922
DOI or Unique Handle: 10.1007/s00134-008-1022-y
Schools and Programs: School of Medicine > Critical Care Medicine
Refereed: Yes
ISSN: 0342-4642
PubMed ID: 18259725
Date Deposited: 05 Mar 2012 17:25
Last Modified: 04 Feb 2019 15:57
URI: http://d-scholarship.pitt.edu/id/eprint/11202

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