Subclinical cardiac dysfunction may impact on fluid and vasopressor administration during early resuscitation of septic shock

Autor: 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
Jazyk: angličtina
Rok vydání: 2023
Předmět:
Zdroj: Journal of Anesthesia, Analgesia and Critical Care, Vol 3, Iss 1, Pp 1-8 (2023)
Druh dokumentu: article
ISSN: 2731-3786
DOI: 10.1186/s44158-023-00117-3
Popis: Abstract 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
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