Document Detail

Early preload adaptation in septic shock? A transesophageal echocardiographic study.
MedLine Citation:
PMID:  11374597     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: An accepted concept in septic shock is that preload adaptation by acute left ventricular dilatation, when occurring spontaneously or with the aid of volume loading, permits maintenance of an adequate cardiac output, leading to final recovery. From a physiologic point of view, this concept appears debatable because a normal pericardium exerts a restraining action on a normal heart. METHODS: During a 26-month period, the authors investigated, by transesophageal echocardiography, 40 patients hospitalized in their unit for an episode of septic shock. Transesophageal echocardiography was performed in the first hours after admission, proceeded by correction of any hypovolemia, and stabilization of arterial pressure by vasoactive agent infusion if necessary. Left ventricular dimensions were obtained in long- and short-axis views, permitting calculation of left ventricular ejection fraction (long axis) and fractional area contraction (short axis). Stroke index was simultaneously measured by the Doppler technique. RESULTS: Stroke index was strongly correlated with both echocardiographic left ventricle ejection fraction (r = 0.75; P < 0.0001) and left ventricle fractional area contraction (r = 0.76; P < 0.0001), whereas it was independent of echocardiographic left ventricle diastolic dimensions. CONCLUSIONS: The transesophageal echocardiography study was unable to confirm the reality of the concept of early preload adaptation by left ventricular dilatation in septic shock. Conversely, because left ventricular volume always remained in a normal range after correcting hypovolemia, systolic function was the unique determinant of stroke index in septic shock.
A Vieillard Baron; J M Schmitt; A Beauchet; R Augarde; S Prin; B Page; F Jardin
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Anesthesiology     Volume:  94     ISSN:  0003-3022     ISO Abbreviation:  Anesthesiology     Publication Date:  2001 Mar 
Date Detail:
Created Date:  2001-05-25     Completed Date:  2001-06-14     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  1300217     Medline TA:  Anesthesiology     Country:  United States    
Other Details:
Languages:  eng     Pagination:  400-6     Citation Subset:  AIM; IM    
Medical Intensive Care Unit, University Hospital Ambroise Paré, Boulogne, France.
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MeSH Terms
Echocardiography, Transesophageal*
Fluid Therapy
Linear Models
Middle Aged
Respiration, Artificial
Shock, Septic / physiopathology*,  therapy
Sympathomimetics / therapeutic use
Reg. No./Substance:
Comment In:
Anesthesiology. 2001 Dec;95(6):1535   [PMID:  11767769 ]

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