Limitations of global end-diastolic volume index as a parameter of cardiac preload in the early phase of severe sepsis: A subgroup analysis of a multicenter, prospective observational study

被引：15

作者：

Endo T. ^{[1
]}

Kushimoto S. ^{[2
]}

Yamanouchi S. ^{[2
]}

Sakamoto T. ^{[3
]}

Ishikura H. ^{[4
]}

Kitazawa Y. ^{[5
]}

Taira Y. ^{[6
]}

Okuchi K. ^{[7
]}

Tagami T. ^{[8
]}

Watanabe A. ^{[8
]}

Yamaguchi J. ^{[9
]}

Yoshikawa K. ^{[10
]}

Sugita M. ^{[11
]}

Kase Y. ^{[12
]}

Kanemura T. ^{[13
]}

Takahashi H. ^{[14
]}

Kuroki Y. ^{[15
]}

Izumino H. ^{[16
]}

Rinka H. ^{[17
]}

Seo R. ^{[18
]}

Takatori M. ^{[19
]}

Kaneko T. ^{[20
]}

Nakamura T. ^{[21
]}

Irahara T. ^{[22
]}

Saito N. ^{[23
]}

PiCCO Pulmonary Edema Study Group

机构：

[1] Department of Emergency and Critical Care Medicine, Tohoku University Hospital, Sendai, Miyagi

[2] Division of Emergency Medicine, Tohoku University Graduate School of Medicine, Sendai, Miyagi

[3] Department of Emergency and Critical Care Medicine, Kurume University School of Medicine, Kurume-shi, Fukuoka

[4] Department of Emergency and Critical Care Medicine, Faculty of Medicine, Fukuoka University, Fukuoka, Fukuoka

[5] Department of Emergency and Critical Care Medicine, Kansai Medical University, Moriguchi, Osaka

[6] Department of Emergency and Critical Care Medicine, St. Marianna University School of Medicine, Kawasaki, Kanagawa

[7] Department of Emergency and Critical Care Medicine, Nara Medical University, Kashihara, Nara

[8] Department of Emergency and Critical Care Medicine, Nippon Medical School Hospital, Bunkyo-ku, Tokyo

[9] Department of Emergency and Critical Care Medicine, Nihon University School of Medicine Itabashi Hospital, Itabashi-ku, Tokyo

[10] Shock Trauma and Emergency Medical Center, Tokyo Medical and Dental University Hospital of Medicine, Bunkyo-ku, Tokyo

[11] Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima-ku, Tokyo

[12] Department of Critical Care Medicine, Jikei University School of Medicine, Minato-ku, Tokyo

[13] Emergency and Critical Care Medicine, National Hospital Organization Disaster Medical Center, Tachikawa-shi, Tokyo

[14] Department of Intensive Care Medicine, Saiseikai Yokohamashi Tobu Hospital, Kanagawa

[15] Department of Emergency and Critical Care Medicine, Social Insurance Chukyo Hospital, Nagoya, Aichi

[16] Advanced Emergency and Critical Care Center, Kansai Medical University Takii Hospital, Moriguchi, Osaka

[17] Emergency and Critical Care Medical Center, Osaka City General Hospital, Miyakojima, Osaka

[18] Intensive Care Unit, Kobe City Medical Center General Hospital, Kobe, Hyogo

[19] Department of Anesthesia and Intensive Care, Hiroshima City Hospital, Hiroshima-shi, Hiroshima

[20] Advanced Medical Emergency and Critical Care Center, Yamaguchi University Hospital, Ube, Yamaguchi

[21] Intensive Care Unit, Nagasaki University Hospital, Sakamoto, Nagasaki

[22] Department of Emergency and Critical Care Medicine, Nippon Medical School Tama Nagayama Hospital, Tama-shi, Tokyo

[23] Department of Emergency and Critical Care Medicine, Nippon Medical School Chiba Hokusou Hospital, Inzai-shi, Chiba

来源：

Journal of Intensive Care | / 1卷 / 1期

关键词：

Diastolic dysfunction; Global end-diastolic volume index; Sepsis-induced myocardial dysfunction; Severe sepsis; Stroke volume variation;

D O I：

10.1186/2052-0492-1-11

中图分类号：

学科分类号：

摘要：

Background: In patients with severe sepsis, depression of cardiac performance is common and is often associated with left ventricular (LV) dilatation to maintain stroke volume. Although it is essential to optimize cardiac preload to maintain tissue perfusion in patients with severe sepsis, the optimal preload remains unknown. This study aimed to evaluate the reliability of global end-diastolic volume index (GEDI) as a parameter of cardiac preload in the early phase of severe sepsis. Methods: Ninety-three mechanically ventilated patients with acute lung injury/acute respiratory distress syndrome secondary to sepsis were enrolled for subgroup analysis in a multicenter, prospective, observational study. Patients were divided into two groups-with sepsis-induced myocardial dysfunction (SIMD) and without SIMD (non-SIMD)- according to a threshold LV ejection fraction (LVEF) of 50% on the day of enrollment. Both groups were further subdivided according to a threshold stroke volume variation (SVV) of 13% as a parameter of fluid responsiveness. Results: On the day of enrollment, there was a positive correlation (r = 0.421, p = 0.045) between GEDI and SVV in the SIMD group, whereas this paradoxical correlation was not found in the non-SIMD group and both groups on day 2. To evaluate the relationship between attainment of cardiac preload optimization and GEDI value, GEDI with SVV ≤13% and SVV >13% was compared in both the SIMD and non-SIMD groups. SVV ≤13% implies the attainment of cardiac preload optimization. Among patients with SIMD, GEDI was higher in patients with SVV >13% than in patients with SVV ≤13% on the day of enrollment (872 [785-996] mL/m2 vs. 640 [597-696] mL/m2; p < 0.001); this finding differed from the generally recognized relationship between GEDI and SVV. However, GEDI was not significantly different between patients with SVV ≤13% and SVV >13% in the non-SIMD group on the day of enrollment and both groups on day 2. Conclusions: In the early phase of severe sepsis in mechanically ventilated patients, there was no constant relationship between GEDI and fluid reserve responsiveness, irrespective of the presence of SIMD. GEDI should be used as a cardiac preload parameter with awareness of its limitations. © 2013 Endo et al.; licensee BioMed Central Ltd.

引用

共 34 条

[1]

Vieillard-Baron A., Septic cardiomyopathy, Ann Intensive Care, 1, (2011)

[2]

Jardin F., Brun-Ney D., Auvert B., Beauchet A., Bourdarias J.P., Sepsis-related cardiogenic shock, Crit Care Med, 18, pp. 1055-1060, (1990)

[3]

Bouhemad B., Nicolas-Robin A., Arbelot C., Arthaud M., Feger F., Rouby J.J., Acute left ventricular dilatation and shock-induced myocardial dysfunction, Crit Care Med, 37, pp. 441-447, (2009)

[4]

Romero-Bermejo F.J., Ruiz-Bailen M., Gil-Cebrian J., Huertos-Ranchal M.J., Sepsis-induced cardiomyopathy, Current Cardiol Rev, 7, pp. 163-183, (2011)

[5]

Parker M.M., Shelhamer J.H., Bacharach S.L., Green M.V., Natanson C., Frederick T.M., Damske B.A., Parrillo J.E., Profound but reversible myocardial depression in patients with septic shock, Ann Intern Med, 100, pp. 483-490, (1984)

[6]

Jardin F., Fourme T., Page B., Loubieres Y., Vieillard-Baron A., Beauchet A., Bourdarias J.P., Persistent preload defect in severe sepsis despite fluid loading: a longitudinal echocardiographic study in patients with septic shock, Chest, 116, pp. 1354-1359, (1999)

[7]

Vieillard-Baron A., Caille V., Charron C., Belliard G., Page B., Jardin F., Actual incidence of global left ventricular hypokinesia in adult septic shock, Crit Care Med, 36, pp. 1701-1706, (2008)

[8]

Charpentier J., Luyt C.E., Fulla Y., Vinsonneau C., Cariou A., Grabar S., Dhainaut J.F., Mira J.P., Chiche J.D., Brain natriuretic peptide: a marker of myocardial dysfunction and prognosis during severe sepsis, Crit Care Med, 32, pp. 660-665, (2004)

[9]

Schneider A.J., Teule G.J., Groeneveld A.B., Nauta J., Heidendal G.A., Thijs L.G., 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, 116, pp. 103-112, (1988)

[10]

Furian T., Aguiar C., Prado K., Ribeiro R.V., Becker L., Martinelli N., Clausell N., Rohde L.E., Biolo A., Ventricular dysfunction and dilation in severe sepsis and septic shock: relation to endothelial function and mortality, J Crit Care, 27, 319, pp. e9-e15, (2012)

← 1 2 3 4 →