Francesco Murgolo, Rossella di Mussi, Antonio Messina, Luigi Pisani, Lidia Dalfino, Antonio Civita, Monica Stufano, Altamura Gianluca, Francesco Staffieri, Nicola Bartolomeo, Savino Spadaro, Nicola Brienza, Salvatore Grasso
{"title":"亚临床心功能障碍可能影响脓毒性休克早期复苏时液体和血管加压剂的使用。","authors":"Francesco Murgolo, Rossella di Mussi, Antonio Messina, Luigi Pisani, Lidia Dalfino, Antonio Civita, Monica Stufano, Altamura Gianluca, Francesco Staffieri, Nicola Bartolomeo, Savino Spadaro, Nicola Brienza, Salvatore Grasso","doi":"10.1186/s44158-023-00117-3","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>According to the Surviving Sepsis Campaign (SSC) fluids and vasopressors are the mainstays of early resuscitation of septic shock while inotropes are indicated in case of tissue hypoperfusion refractory to fluids and vasopressors, suggesting severe cardiac dysfunction. However, septic cardiac disfunction encompasses a large spectrum of severities and may remain \"subclinical\" during early resuscitation. We hypothesized that \"subclinical\" cardiac dysfunction may nevertheless influence fluid and vasopressor administration during early resuscitation. We retrospectively reviewed prospectically collected data on fluids and vasoconstrictors administered outside the ICU in patients with septic shock resuscitated according to the SSC guidelines that had reached hemodynamic stability without the use of inotropes. All the patients were submitted to transpulmonary thermodilution (TPTD) hemodynamic monitoring at ICU entry. Subclinical cardiac dysfunction was defined as a TPTD-derived cardiac function index (CFI) ≤ 4.5 min<sup>-1</sup>.</p><p><strong>Results: </strong>At ICU admission, subclinical cardiac dysfunction was present in 17/40 patients (42%; CFI 3.6 ± 0.7 min<sup>-1</sup> vs 6.6 ± 1.9 min<sup>-1</sup>; p < 0.01). Compared with patients with normal CFI, these patients had been resuscitate with more fluids (crystalloids 57 ± 10 vs 47 ± 9 ml/kg PBW; p < 0.01) and vasopressors (norepinephrine 0.65 ± 0.25 vs 0.43 ± 0.29 mcg/kg/min; p < 0.05). At ICU admission these patients had lower cardiac index (2.2 ± 0.6 vs 3.6 ± 0.9 L/min/m<sup>2</sup>, p < 0.01) and higher systemic vascular resistances (2721 ± 860 vs 1532 ± 480 dyn*s*cm<sup>-5</sup>/m<sup>2</sup>, p < 0.01).</p><p><strong>Conclusions: </strong>In patients with septic shock resuscitated according to the SSC, we found that subclinical cardiac dysfunction may influence the approach to fluids and vasopressor administration during early resuscitation. Our data support the implementation of early, bedside assessment of cardiac function during early resuscitation of septic shock.</p>","PeriodicalId":73597,"journal":{"name":"Journal of Anesthesia, Analgesia and Critical Care (Online)","volume":null,"pages":null},"PeriodicalIF":0.0000,"publicationDate":"2023-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10463881/pdf/","citationCount":"0","resultStr":"{\"title\":\"Subclinical cardiac dysfunction may impact on fluid and vasopressor administration during early resuscitation of septic shock.\",\"authors\":\"Francesco Murgolo, Rossella di Mussi, Antonio Messina, Luigi Pisani, Lidia Dalfino, Antonio Civita, Monica Stufano, Altamura Gianluca, Francesco Staffieri, Nicola Bartolomeo, Savino Spadaro, Nicola Brienza, Salvatore Grasso\",\"doi\":\"10.1186/s44158-023-00117-3\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>According to the Surviving Sepsis Campaign (SSC) fluids and vasopressors are the mainstays of early resuscitation of septic shock while inotropes are indicated in case of tissue hypoperfusion refractory to fluids and vasopressors, suggesting severe cardiac dysfunction. However, septic cardiac disfunction encompasses a large spectrum of severities and may remain \\\"subclinical\\\" during early resuscitation. We hypothesized that \\\"subclinical\\\" cardiac dysfunction may nevertheless influence fluid and vasopressor administration during early resuscitation. We retrospectively reviewed prospectically collected data on fluids and vasoconstrictors administered outside the ICU in patients with septic shock resuscitated according to the SSC guidelines that had reached hemodynamic stability without the use of inotropes. All the patients were submitted to transpulmonary thermodilution (TPTD) hemodynamic monitoring at ICU entry. Subclinical cardiac dysfunction was defined as a TPTD-derived cardiac function index (CFI) ≤ 4.5 min<sup>-1</sup>.</p><p><strong>Results: </strong>At ICU admission, subclinical cardiac dysfunction was present in 17/40 patients (42%; CFI 3.6 ± 0.7 min<sup>-1</sup> vs 6.6 ± 1.9 min<sup>-1</sup>; p < 0.01). Compared with patients with normal CFI, these patients had been resuscitate with more fluids (crystalloids 57 ± 10 vs 47 ± 9 ml/kg PBW; p < 0.01) and vasopressors (norepinephrine 0.65 ± 0.25 vs 0.43 ± 0.29 mcg/kg/min; p < 0.05). At ICU admission these patients had lower cardiac index (2.2 ± 0.6 vs 3.6 ± 0.9 L/min/m<sup>2</sup>, p < 0.01) and higher systemic vascular resistances (2721 ± 860 vs 1532 ± 480 dyn*s*cm<sup>-5</sup>/m<sup>2</sup>, p < 0.01).</p><p><strong>Conclusions: </strong>In patients with septic shock resuscitated according to the SSC, we found that subclinical cardiac dysfunction may influence the approach to fluids and vasopressor administration during early resuscitation. Our data support the implementation of early, bedside assessment of cardiac function during early resuscitation of septic shock.</p>\",\"PeriodicalId\":73597,\"journal\":{\"name\":\"Journal of Anesthesia, Analgesia and Critical Care (Online)\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":0.0000,\"publicationDate\":\"2023-08-28\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10463881/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of Anesthesia, Analgesia and Critical Care (Online)\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.1186/s44158-023-00117-3\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"\",\"JCRName\":\"\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Anesthesia, Analgesia and Critical Care (Online)","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1186/s44158-023-00117-3","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"","JCRName":"","Score":null,"Total":0}
引用次数: 0
摘要
背景:根据生存脓毒症运动(SSC),液体和血管升压药是脓毒症休克早期复苏的主要手段,而当组织灌注不足,液体和血管升压药难治性时,表明严重的心功能障碍,则需要使用收缩性药物。然而,脓毒性心功能障碍包括大范围的严重程度,并可能在早期复苏期间保持“亚临床”状态。我们假设“亚临床”心功能障碍可能会影响早期复苏时液体和血管加压剂的给药。我们回顾性回顾了前瞻性收集的脓毒性休克患者在ICU外给予液体和血管收缩剂的数据,这些患者根据SSC指南在不使用收缩剂的情况下达到血流动力学稳定。所有患者入ICU时均行经肺热调节(TPTD)血流动力学监测。亚临床心功能障碍定义为tptd衍生的心功能指数(CFI)≤4.5 min-1。结果:在ICU入院时,有17/40的患者存在亚临床心功能障碍(42%;CFI 3.6±0.7 min-1 vs 6.6±1.9 min-1;结论:在根据SSC复苏的脓毒性休克患者中,我们发现亚临床心功能障碍可能影响早期复苏时液体和血管加压剂的使用方法。我们的数据支持在脓毒性休克早期复苏过程中对心功能进行早期床边评估。
Subclinical cardiac dysfunction may impact on fluid and vasopressor administration during early resuscitation of septic shock.
Background: According to the Surviving Sepsis Campaign (SSC) fluids and vasopressors are the mainstays of early resuscitation of septic shock while inotropes are indicated in case of tissue hypoperfusion refractory to fluids and vasopressors, suggesting severe cardiac dysfunction. However, septic cardiac disfunction encompasses a large spectrum of severities and may remain "subclinical" during early resuscitation. We hypothesized that "subclinical" cardiac dysfunction may nevertheless influence fluid and vasopressor administration during early resuscitation. We retrospectively reviewed prospectically collected data on fluids and vasoconstrictors administered outside the ICU in patients with septic shock resuscitated according to the SSC guidelines that had reached hemodynamic stability without the use of inotropes. All the patients were submitted to transpulmonary thermodilution (TPTD) hemodynamic monitoring at ICU entry. Subclinical cardiac dysfunction was defined as a TPTD-derived cardiac function index (CFI) ≤ 4.5 min-1.
Results: At ICU admission, subclinical cardiac dysfunction was present in 17/40 patients (42%; CFI 3.6 ± 0.7 min-1 vs 6.6 ± 1.9 min-1; p < 0.01). Compared with patients with normal CFI, these patients had been resuscitate with more fluids (crystalloids 57 ± 10 vs 47 ± 9 ml/kg PBW; p < 0.01) and vasopressors (norepinephrine 0.65 ± 0.25 vs 0.43 ± 0.29 mcg/kg/min; p < 0.05). At ICU admission these patients had lower cardiac index (2.2 ± 0.6 vs 3.6 ± 0.9 L/min/m2, p < 0.01) and higher systemic vascular resistances (2721 ± 860 vs 1532 ± 480 dyn*s*cm-5/m2, p < 0.01).
Conclusions: In patients with septic shock resuscitated according to the SSC, we found that subclinical cardiac dysfunction may influence the approach to fluids and vasopressor administration during early resuscitation. Our data support the implementation of early, bedside assessment of cardiac function during early resuscitation of septic shock.