Ventriculoarterial decoupling in human septic shock
Identifieur interne : 000876 ( Main/Exploration ); précédent : 000875; suivant : 000877Ventriculoarterial decoupling in human septic shock
Auteurs : Fabio Guarracino [Italie] ; Baldassare Ferro [Italie] ; Andrea Morelli [Italie] ; Pietro Bertini [Italie] ; Rubia Baldassarri [Italie] ; Michael R. Pinsky [États-Unis]Source :
- Critical Care [ 1364-8535 ] ; 2014.
Abstract
Septic shock is the most severe manifestation of sepsis. It is characterized as a hypotensive cardiovascular state associated with multiorgan dysfunction and metabolic disturbances. Management of septic shock is targeted at preserving adequate organ perfusion pressure without precipitating pulmonary edema or massive volume overload. Cardiac dysfunction often occurs in septic shock patients and can significantly affect outcomes. One physiologic approach to detect the interaction between the heart and the circulation when both are affected is to examine ventriculoarterial coupling, which is defined by the ratio of arterial elastance (Ea) to left ventricular end-systolic elastance (Ees). In this study, we analyzed ventriculoarterial coupling in a cohort of patients admitted to ICUs who presented with vs without septic shock.
In this retrospective cross-sectional opportunity study, we measured routine hemodynamics using indwelling arterial and pulmonary arterial catheters and transthoracic echocardiograms in 25 septic patients (group S) and 25 non–septic shock patients (group C) upon ICU admission. Ees was measured by echocardiography using a single-beat (EesSB) method. Ea was calculated as 0.9 systolic arterial pressure/stroke volume, and then the Ea/EesSB ratio was calculated (normal value <1.36).
In group S, 21 patients had an Ea/EesSB ratio >1.36 (uncoupled). The four patients with Ea/EesSB ratios ≤1.36 had higher EesSB values than patients with Ea/EesSB ratios >1.36 (
Upon admission to the ICU, patients in septic shock often display significant ventriculoarterial decoupling that is associated with impaired left ventricular performance. Because Ea/Ees decoupling alters cardiovascular efficiency and cardiac energetic requirements independently of Ea or Ees, we speculate that septic patients with ventriculoarterial uncoupling may benefit from therapy aimed at normalizing the Ea/Ees ratio.
Url:
DOI: 10.1186/cc13842
PubMed: 24762124
PubMed Central: 4056562
Affiliations:
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<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">Ventriculoarterial decoupling in human septic shock</title><author><name sortKey="Guarracino, Fabio" sort="Guarracino, Fabio" uniqKey="Guarracino F" first="Fabio" last="Guarracino">Fabio Guarracino</name><affiliation wicri:level="1"><nlm:aff id="I1">Department of Anesthesia and Critical Care Medicine, University Hospital of Pisa, Via Paradisa 2, Pisa 56124, Italy</nlm:aff><country xml:lang="fr">Italie</country><wicri:regionArea>Department of Anesthesia and Critical Care Medicine, University Hospital of Pisa, Via Paradisa 2, Pisa 56124</wicri:regionArea><placeName><settlement type="city">Pise</settlement><region nuts="2">Toscane</region></placeName></affiliation></author><author><name sortKey="Ferro, Baldassare" sort="Ferro, Baldassare" uniqKey="Ferro B" first="Baldassare" last="Ferro">Baldassare Ferro</name><affiliation wicri:level="1"><nlm:aff id="I1">Department of Anesthesia and Critical Care Medicine, University Hospital of Pisa, Via Paradisa 2, Pisa 56124, Italy</nlm:aff><country xml:lang="fr">Italie</country><wicri:regionArea>Department of Anesthesia and Critical Care Medicine, University Hospital of Pisa, Via Paradisa 2, Pisa 56124</wicri:regionArea><placeName><settlement type="city">Pise</settlement><region nuts="2">Toscane</region></placeName></affiliation></author><author><name sortKey="Morelli, Andrea" sort="Morelli, Andrea" uniqKey="Morelli A" first="Andrea" last="Morelli">Andrea Morelli</name><affiliation wicri:level="1"><nlm:aff id="I2">Department of Anesthesiology and Intensive Care, University of Rome, “La Sapienza”, Viale del Policlinico 155, Rome 00161, Italy</nlm:aff><country xml:lang="fr">Italie</country><wicri:regionArea>Department of Anesthesiology and Intensive Care, University of Rome, “La Sapienza”, Viale del Policlinico 155, Rome 00161</wicri:regionArea><placeName><settlement type="city">Rome</settlement><region nuts="2">Latium</region></placeName></affiliation></author><author><name sortKey="Bertini, Pietro" sort="Bertini, Pietro" uniqKey="Bertini P" first="Pietro" last="Bertini">Pietro Bertini</name><affiliation wicri:level="1"><nlm:aff id="I1">Department of Anesthesia and Critical Care Medicine, University Hospital of Pisa, Via Paradisa 2, Pisa 56124, Italy</nlm:aff><country xml:lang="fr">Italie</country><wicri:regionArea>Department of Anesthesia and Critical Care Medicine, University Hospital of Pisa, Via Paradisa 2, Pisa 56124</wicri:regionArea><placeName><settlement type="city">Pise</settlement><region nuts="2">Toscane</region></placeName></affiliation></author><author><name sortKey="Baldassarri, Rubia" sort="Baldassarri, Rubia" uniqKey="Baldassarri R" first="Rubia" last="Baldassarri">Rubia Baldassarri</name><affiliation wicri:level="1"><nlm:aff id="I1">Department of Anesthesia and Critical Care Medicine, University Hospital of Pisa, Via Paradisa 2, Pisa 56124, Italy</nlm:aff><country xml:lang="fr">Italie</country><wicri:regionArea>Department of Anesthesia and Critical Care Medicine, University Hospital of Pisa, Via Paradisa 2, Pisa 56124</wicri:regionArea><placeName><settlement type="city">Pise</settlement><region nuts="2">Toscane</region></placeName></affiliation></author><author><name sortKey="Pinsky, Michael R" sort="Pinsky, Michael R" uniqKey="Pinsky M" first="Michael R" last="Pinsky">Michael R. Pinsky</name><affiliation wicri:level="4"><nlm:aff id="I3">Department of Critical Care Medicine, University of Pittsburgh, 606 Scaife Hall, 3550 Terrace St, Pittsburgh, PA 15213, USA</nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Department of Critical Care Medicine, University of Pittsburgh, 606 Scaife Hall, 3550 Terrace St, Pittsburgh, PA 15213</wicri:regionArea><placeName><region type="state">Pennsylvanie</region><settlement type="city">Pittsburgh</settlement></placeName><orgName type="university">Université de Pittsburgh</orgName></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">24762124</idno><idno type="pmc">4056562</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4056562</idno><idno type="RBID">PMC:4056562</idno><idno type="doi">10.1186/cc13842</idno><date when="2014">2014</date><idno type="wicri:Area/Pmc/Corpus">000761</idno><idno type="wicri:explorRef" wicri:stream="Pmc" 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last="Guarracino">Fabio Guarracino</name><affiliation wicri:level="1"><nlm:aff id="I1">Department of Anesthesia and Critical Care Medicine, University Hospital of Pisa, Via Paradisa 2, Pisa 56124, Italy</nlm:aff><country xml:lang="fr">Italie</country><wicri:regionArea>Department of Anesthesia and Critical Care Medicine, University Hospital of Pisa, Via Paradisa 2, Pisa 56124</wicri:regionArea><placeName><settlement type="city">Pise</settlement><region nuts="2">Toscane</region></placeName></affiliation></author><author><name sortKey="Ferro, Baldassare" sort="Ferro, Baldassare" uniqKey="Ferro B" first="Baldassare" last="Ferro">Baldassare Ferro</name><affiliation wicri:level="1"><nlm:aff id="I1">Department of Anesthesia and Critical Care Medicine, University Hospital of Pisa, Via Paradisa 2, Pisa 56124, Italy</nlm:aff><country xml:lang="fr">Italie</country><wicri:regionArea>Department of Anesthesia and Critical Care Medicine, University Hospital of Pisa, Via Paradisa 2, Pisa 56124</wicri:regionArea><placeName><settlement type="city">Pise</settlement><region nuts="2">Toscane</region></placeName></affiliation></author><author><name sortKey="Morelli, Andrea" sort="Morelli, Andrea" uniqKey="Morelli A" first="Andrea" last="Morelli">Andrea Morelli</name><affiliation wicri:level="1"><nlm:aff id="I2">Department of Anesthesiology and Intensive Care, University of Rome, “La Sapienza”, Viale del Policlinico 155, Rome 00161, Italy</nlm:aff><country xml:lang="fr">Italie</country><wicri:regionArea>Department of Anesthesiology and Intensive Care, University of Rome, “La Sapienza”, Viale del Policlinico 155, Rome 00161</wicri:regionArea><placeName><settlement type="city">Rome</settlement><region nuts="2">Latium</region></placeName></affiliation></author><author><name sortKey="Bertini, Pietro" sort="Bertini, Pietro" uniqKey="Bertini P" first="Pietro" last="Bertini">Pietro Bertini</name><affiliation wicri:level="1"><nlm:aff id="I1">Department of Anesthesia and Critical Care Medicine, University Hospital of Pisa, Via Paradisa 2, Pisa 56124, Italy</nlm:aff><country xml:lang="fr">Italie</country><wicri:regionArea>Department of Anesthesia and Critical Care Medicine, University Hospital of Pisa, Via Paradisa 2, Pisa 56124</wicri:regionArea><placeName><settlement type="city">Pise</settlement><region nuts="2">Toscane</region></placeName></affiliation></author><author><name sortKey="Baldassarri, Rubia" sort="Baldassarri, Rubia" uniqKey="Baldassarri R" first="Rubia" last="Baldassarri">Rubia Baldassarri</name><affiliation wicri:level="1"><nlm:aff id="I1">Department of Anesthesia and Critical Care Medicine, University Hospital of Pisa, Via Paradisa 2, Pisa 56124, Italy</nlm:aff><country xml:lang="fr">Italie</country><wicri:regionArea>Department of Anesthesia and Critical Care Medicine, University Hospital of Pisa, Via Paradisa 2, Pisa 56124</wicri:regionArea><placeName><settlement type="city">Pise</settlement><region nuts="2">Toscane</region></placeName></affiliation></author><author><name sortKey="Pinsky, Michael R" sort="Pinsky, Michael R" uniqKey="Pinsky M" first="Michael R" last="Pinsky">Michael R. Pinsky</name><affiliation wicri:level="4"><nlm:aff id="I3">Department of Critical Care Medicine, University of Pittsburgh, 606 Scaife Hall, 3550 Terrace St, Pittsburgh, PA 15213, USA</nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Department of Critical Care Medicine, University of Pittsburgh, 606 Scaife Hall, 3550 Terrace St, Pittsburgh, PA 15213</wicri:regionArea><placeName><region type="state">Pennsylvanie</region><settlement type="city">Pittsburgh</settlement></placeName><orgName type="university">Université de Pittsburgh</orgName></affiliation></author></analytic><series><title level="j">Critical Care</title><idno type="ISSN">1364-8535</idno><idno type="eISSN">1466-609X</idno><imprint><date when="2014">2014</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec><title>Introduction</title><p>Septic shock is the most severe manifestation of sepsis. It is characterized as a hypotensive cardiovascular state associated with multiorgan dysfunction and metabolic disturbances. Management of septic shock is targeted at preserving adequate organ perfusion pressure without precipitating pulmonary edema or massive volume overload. Cardiac dysfunction often occurs in septic shock patients and can significantly affect outcomes. One physiologic approach to detect the interaction between the heart and the circulation when both are affected is to examine ventriculoarterial coupling, which is defined by the ratio of arterial elastance (Ea) to left ventricular end-systolic elastance (Ees). In this study, we analyzed ventriculoarterial coupling in a cohort of patients admitted to ICUs who presented with vs without septic shock.</p></sec><sec><title>Methods</title><p>In this retrospective cross-sectional opportunity study, we measured routine hemodynamics using indwelling arterial and pulmonary arterial catheters and transthoracic echocardiograms in 25 septic patients (group S) and 25 non–septic shock patients (group C) upon ICU admission. Ees was measured by echocardiography using a single-beat (Ees<sub>SB</sub>) method. Ea was calculated as 0.9 systolic arterial pressure/stroke volume, and then the Ea/Ees<sub>SB</sub> ratio was calculated (normal value <1.36).</p></sec><sec><title>Results</title><p>In group S, 21 patients had an Ea/Ees<sub>SB</sub> ratio >1.36 (uncoupled). The four patients with Ea/Ees<sub>SB</sub> ratios ≤1.36 had higher Ees<sub>SB</sub> values than patients with Ea/Ees<sub>SB</sub> ratios >1.36 (<italic>P</italic> = 0.007), although Ea measurements were similar in both groups (<italic>P</italic> = 0.4). In group C, five patients had uncoupled Ea/Ees<sub>SB</sub> ratios. No correlation was found between Ees<sub>SB</sub> and left ventricular ejection fraction and between Ea/Ees<sub>SB</sub> ratio and mixed venous oxygen saturation in septic shock patients.</p></sec><sec><title>Conclusions</title><p>Upon admission to the ICU, patients in septic shock often display significant ventriculoarterial decoupling that is associated with impaired left ventricular performance. Because Ea/Ees decoupling alters cardiovascular efficiency and cardiac energetic requirements independently of Ea or Ees, we speculate that septic patients with ventriculoarterial uncoupling may benefit from therapy aimed at normalizing the Ea/Ees ratio.</p></sec></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Werdan, K" uniqKey="Werdan K">K Werdan</name></author><author><name sortKey="Muller Werdan, U" uniqKey="Muller Werdan U">U Müller-Werdan</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Flierl, Ma" uniqKey="Flierl M">MA Flierl</name></author><author><name sortKey="Rittirsch, D" uniqKey="Rittirsch D">D Rittirsch</name></author><author><name sortKey="Huber Lang, Ms" uniqKey="Huber Lang M">MS Huber-Lang</name></author><author><name sortKey="Sarma, Jv" uniqKey="Sarma J">JV Sarma</name></author><author><name sortKey="Ward, Pa" uniqKey="Ward P">PA 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uniqKey="Chang M">MC Chang</name></author><author><name sortKey="Morris, Ja" uniqKey="Morris J">JA Morris</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Ducrocq, N" uniqKey="Ducrocq N">N Ducrocq</name></author><author><name sortKey="Kimmoun, A" uniqKey="Kimmoun A">A Kimmoun</name></author><author><name sortKey="Furmaniuk, A" uniqKey="Furmaniuk A">A Furmaniuk</name></author><author><name sortKey="Hekalo, Z" uniqKey="Hekalo Z">Z Hekalo</name></author><author><name sortKey="Maskali, F" uniqKey="Maskali F">F Maskali</name></author><author><name sortKey="Poussier, S" uniqKey="Poussier S">S Poussier</name></author><author><name sortKey="Marie, Py" uniqKey="Marie P">PY Marie</name></author><author><name sortKey="Levy, B" uniqKey="Levy B">B Levy</name></author></analytic></biblStruct></listBibl></div1></back></TEI><affiliations><list><country><li>Italie</li><li>États-Unis</li></country><region><li>Latium</li><li>Pennsylvanie</li><li>Toscane</li></region><settlement><li>Pise</li><li>Pittsburgh</li><li>Rome</li></settlement><orgName><li>Université de Pittsburgh</li></orgName></list><tree><country name="Italie"><region name="Toscane"><name sortKey="Guarracino, Fabio" sort="Guarracino, Fabio" uniqKey="Guarracino F" first="Fabio" last="Guarracino">Fabio Guarracino</name></region><name sortKey="Baldassarri, Rubia" sort="Baldassarri, Rubia" uniqKey="Baldassarri R" first="Rubia" last="Baldassarri">Rubia Baldassarri</name><name sortKey="Bertini, Pietro" sort="Bertini, Pietro" uniqKey="Bertini P" first="Pietro" last="Bertini">Pietro Bertini</name><name sortKey="Ferro, Baldassare" sort="Ferro, Baldassare" uniqKey="Ferro B" first="Baldassare" last="Ferro">Baldassare Ferro</name><name sortKey="Morelli, Andrea" sort="Morelli, Andrea" uniqKey="Morelli A" first="Andrea" last="Morelli">Andrea Morelli</name></country><country name="États-Unis"><region name="Pennsylvanie"><name sortKey="Pinsky, Michael R" sort="Pinsky, Michael R" uniqKey="Pinsky M" first="Michael R" last="Pinsky">Michael R. 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