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Ventriculoarterial decoupling in human septic shock

Guarracino, F and Ferro, B and Morelli, A and Bertini, P and Baldassarri, R and Pinsky, MR (2014) Ventriculoarterial decoupling in human septic shock. Critical Care, 18 (2). ISSN 1364-8535

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Abstract

Introduction: Septic shock is the most severe manifestation of sepsis. It is characterized as a hypotensive cardiovascular state associated with multiorgan dysfunction and metabolic disturbances. Management of septic shock is targeted at preserving adequate organ perfusion pressure without precipitating pulmonary edema or massive volume overload. Cardiac dysfunction often occurs in septic shock patients and can significantly affect outcomes. One physiologic approach to detect the interaction between the heart and the circulation when both are affected is to examine ventriculoarterial coupling, which is defined by the ratio of arterial elastance (Ea) to left ventricular end-systolic elastance (Ees). In this study, we analyzed ventriculoarterial coupling in a cohort of patients admitted to ICUs who presented with vs without septic shock.Methods: In this retrospective cross-sectional opportunity study, we measured routine hemodynamics using indwelling arterial and pulmonary arterial catheters and transthoracic echocardiograms in 25 septic patients (group S) and 25 non-septic shock patients (group C) upon ICU admission. Ees was measured by echocardiography using a single-beat (EesSB) method. Ea was calculated as 0.9 systolic arterial pressure/stroke volume, and then the Ea/EesSB ratio was calculated (normal value <1.36).Results: In group S, 21 patients had an Ea/EesSB ratio >1.36 (uncoupled). The four patients with Ea/EesSB ratios ≤1.36 had higher EesSB values than patients with Ea/EesSB ratios >1.36 (P = 0.007), although Ea measurements were similar in both groups (P = 0.4). In group C, five patients had uncoupled Ea/EesSB ratios. No correlation was found between EesSB and left ventricular ejection fraction and between Ea/EesSB ratio and mixed venous oxygen saturation in septic shock patients.Conclusions: Upon admission to the ICU, patients in septic shock often display significant ventriculoarterial decoupling that is associated with impaired left ventricular performance. Because Ea/Ees decoupling alters cardiovascular efficiency and cardiac energetic requirements independently of Ea or Ees, we speculate that septic patients with ventriculoarterial uncoupling may benefit from therapy aimed at normalizing the Ea/Ees ratio. © 2014 Guarracino et al.; licensee BioMed Central Ltd.


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Details

Item Type: Article
Status: Published
Creators/Authors:
CreatorsEmailPitt UsernameORCID
Guarracino, F
Ferro, B
Morelli, A
Bertini, P
Baldassarri, R
Pinsky, MRpinsky@pitt.eduPINSKY0000-0001-6166-700X
Date: 24 April 2014
Date Type: Publication
Journal or Publication Title: Critical Care
Volume: 18
Number: 2
DOI or Unique Handle: 10.1186/cc13842
Schools and Programs: School of Medicine > Critical Care Medicine
Refereed: Yes
ISSN: 1364-8535
Date Deposited: 05 Dec 2016 21:12
Last Modified: 30 Jan 2020 16:56
URI: http://d-scholarship.pitt.edu/id/eprint/29568

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