| Cardiac morphological and functional changes during early septic shock: a transesophageal echocardiographic study. | |
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MedLine Citation:
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PMID: 18004543 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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OBJECTIVE: The objective was to prospectively evaluate cardiac morphological and functional changes using transesophageal echocardiography (TEE) during early septic shock. DESIGN: Prospective, observational study. SETTING: Medical-surgical intensive care unit of a teaching hospital. PATIENTS AND PARTICIPANTS: Ventilated patients with septic shock, sinus rhythm and no cardiac disease underwent TEE within 12h of admission (Day0), after stabilization of hemodynamics by fluid loading (median volume: 4.9l [lower and upper quartiles: 3.7-9.6l]) and vasopressor therapy, and after vasopressors were stopped (Dayn). MEASUREMENTS AND RESULTS: Thirty-five patients were studied (median age: 60 years [range 44-68]; SAPS II: 53 [46-62]; SOFA score: 9 [8-11]) and 9 of them (26%) died while on vasopressors. None of the patients exhibited TEE findings of cardiac preload dependence. Between Day0 and Dayn (7 days [range 6-9]), mean left ventricular (LV) ejection fraction (EF) increased (47 +/- 20 vs. 57 +/- 14%: p < 0.05), whereas mean LV end-diastolic volume decreased (97 +/- 25 vs. 75 +/- 20ml: p < 0.0001). Out of 16 patients (46%) with LV systolic dysfunction on Day0, 12 had normal LVEF on Dayn and 4 patients fully recovered by Day28. Only 4 women had LV dilatation (range, LV end-diastolic volume: 110-148ml) on Day0, but none on Dayn. Doppler tissue imaging identified an LV diastolic dysfunction in 7 patients (20%) on Day0 (3 with normal LVEF), which resolved on Dayn. CONCLUSIONS: This study confirms that LV systolic and diastolic dysfunctions are frequent, but LV dilatation is uncommon in fluid-loaded septic patients on vasopressors. All abnormalities regressed in survivors, regardless of their severity. DESCRIPTORS: Shock: clinical studies (38), Cardiovascular monitoring (34). |
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Authors:
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Caroline Etchecopar-Chevreuil; Bruno François; Marc Clavel; Nicolas Pichon; Hervé Gastinne; Philippe Vignon |
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Publication Detail:
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Type: Journal Article Date: 2007-11-15 |
Journal Detail:
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Title: Intensive care medicine Volume: 34 ISSN: 0342-4642 ISO Abbreviation: Intensive Care Med Publication Date: 2008 Feb |
Date Detail:
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Created Date: 2008-02-05 Completed Date: 2008-06-17 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 7704851 Medline TA: Intensive Care Med Country: United States |
Other Details:
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Languages: eng Pagination: 250-6 Citation Subset: IM |
Affiliation:
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Dupuytren Teaching Hospital, Medical-Surgical Intensive Care Unit, 2 Avenue Martin Luther King, 87042 Limoges Cedex, France. |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Adult Aged Echocardiography, Transesophageal* Female Hemodynamics Humans Male Middle Aged Prospective Studies Resuscitation / methods Shock, Septic / physiopathology*, ultrasonography* Statistics, Nonparametric Ventricular Dysfunction, Left / physiopathology*, ultrasonography* |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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