Document Detail

Accuracy in early prediction of prognosis of patients with septic shock by analysis of simple indices: prospective study.
MedLine Citation:
PMID:  2245606     Owner:  NLM     Status:  MEDLINE    
In 26 consecutive septic shock patients, we analyzed the clinical, hemodynamic, and metabolic data before and during volume infusion to test their circulatory reserve in response to fluid repletion. These patients were investigated to identify early variables that could predict outcome. There were 15 survivors (group A) and 11 nonsurvivors (group B). As a mean, group A patients were hemodynamically evaluated 2.3 h after onset of the sepsis syndrome, whereas group B patients underwent cardiac catheterization after a 12-h interval. At the initial evaluation, both groups demonstrated similarly decreased mean arterial pressure, mean heart rate, and mean cardiac filling pressure. Only group A patients evidenced elevated cardiac index (CI) (greater than 4 L/min.m2) associated with low systemic vascular resistance index (less than 7400 dyne.sec/cm5.m2), which is generally recognized as hyperdynamic cardiac state. However, none of the initial cardiovascular variables could serve as a predictor for survival. Fluid challenge increased left ventricular preload from 6 to 12.4 and from 7.8 to 12.7 mm Hg in group A and group B, respectively. The increases were associated with significant increases in CI from 4.4 to 6.9 and from 3 to 3.8 L/min.m2. However, at the end of fluid challenge, only group A patients exhibited normal cardiac response, as evidenced by the change in left ventricular stroke work index (LVSWI) for a given increase in the pulmonary capillary wedge pressure (WP) that was referred to as left cardiac preload.(ABSTRACT TRUNCATED AT 250 WORDS)
V D'Orio; P Mendes; G Saad; R Marcelle
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Critical care medicine     Volume:  18     ISSN:  0090-3493     ISO Abbreviation:  Crit. Care Med.     Publication Date:  1990 Dec 
Date Detail:
Created Date:  1991-01-07     Completed Date:  1991-01-07     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  0355501     Medline TA:  Crit Care Med     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  1339-45     Citation Subset:  AIM; IM    
Hôpital Universitaire du Sart Tilman, Unité Soins Intensifs Médicaux, Liege, Belgium.
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MeSH Terms
Evaluation Studies as Topic
Fluid Therapy / standards*
Heart Catheterization / standards
Intensive Care Units
Middle Aged
Oxygen Consumption
Patient Admission
Predictive Value of Tests
Prospective Studies
Shock, Septic / metabolism,  mortality*,  physiopathology
Survival Analysis
Survival Rate

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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