CHEST
Clinical Investigations in Critical CareRespiratory Changes in Aortic Blood Velocity as an Indicator of Fluid Responsiveness in Ventilated Patients With Septic Shock
Section snippets
Materials and Methods
The protocol was approved by the institutional review board forhuman subjects of our institutions, and written informed consent wasobtained from each patient's next of kin.
Results
The 19 patients studied had clear evidence of sepsis (abdominalsepsis, 10 patients; bacterial pneumonia, 9 patients). All patientsreceived inotropic and vasopressor drugs. Thirteen patients receivedepinephrine (0.3 to 2.5μg/kg/min; mean dose, 1.4 ± 0.6μg/kg/min), 6 patients received dopamine (12 to 20μg/kg/min; meandose, 16 ± 4μg/kg/min), and 11 patients received dobutamine (5μg/kg/min). Transesophageal echocardiography was performed between 12and 72 h after the diagnosis of septic shock.
Discussion
In patients with septic shock who are receiving mechanicalventilation, our results demonstrate a strong relationship between ΔVpeak and the effects of volume expansion on cardiac output. Theystrongly suggest that ΔVpeak before volume expansion is an accurateindicator of fluid responsiveness while EDAI is of little value inpredicting the effects of volume expansion on cardiac output.
Volume expansion is proposed as a first-line therapy for septic shockin order to improve hemodynamics.16 Both the
ACKNOWLEDGMENT
The authors thank Dr. Denis Pellerin and SuzanneKelly for helpful discussion.
References (30)
- et al.
Septic shock
Lancet
(1998) - et al.
Biventricular performance during volume loading in patients with early septic shock, with emphasis on the right ventricle: a combined hemodynamic and radionuclide study
Am Heart J
(1988) - et al.
Right ventricular performance in septic shock: a combined radionuclide and hemodynamic study
J Am Coll Cardiol
(1984) - et al.
Estimation of left ventricular volume and ejection fraction by two-dimensional transesophageal echocardiography: comparison of short axis imaging and simultaneous radionuclide angiography
Br J Anaesth
(1990) - et al.
A bedside index assessing the reliability of pulmonary occlusion pressure measurements during mechanical ventilation with positive end-expiratory pressure
J Crit Care
(1992) - et al.
Multiplane transesophageal echocardiographic acquisition of ascending aortic flow velocities: a comparison with established techniques
J Am Soc Echocardiogr
(1999) - et al.
Multiplane transesophageal echocardiographic doppler imaging accurately determines cardiac output measurements in critically ill patients
Chest
(1995) - et al.
Transesophageal echocardiography
N Engl J Med
(1995) - et al.
The effectiveness of right heart catheterization in the initial care of critically ill patients
JAMA
(1996) - et al.
A comparison of hemodynamic indices derived by invasive monitoring and two-dimensional echocardiography
Anesthesiology
(1987)