Evaluation of cardiac function in septics patients by the PiCCO system

Background and goal of study

Myocardial dysfunction is a fundamental aspect of sepsis, but goal-directed therapy and accurate diagnosis at the bedside is a difficult challenge. We have evaluated myocardial function in the initial phase of sepsis by PiCCO device (pulse contour analysis and transpulmonary technique).

Materials and methods

Fifteen septic patients (Group A) and 15 nonseptic patients (Group B) were enrolled in this randomised, double-blind study and monitored by optical femoral artery catether and central vein catether for hemodynamic measurement. Cardiac output (CO), extravascular lung water index (EVLWI), intrathoracic blood volume index (ITBVI), DpDt max and stroke volume variation (SVV%) were measured. The hemodynamic and volumetric data were studied at T0 (basal), T1 (after colloid infusion 8 ± 4 ml/kg hydroxyethyl starch 130/0.4 for intravascular volume replacement) and T2 (inotropic support as dobutamine 4.5–7 μg/kg/min infusion for 45 min). Statistical analysis was performed by ANOVA test for repeated measurement. Data are shown as mean ± SD. A linear regression analysis was performed to evaluate correlation between indexes of cardiac function and preload indexes.

Results

Table 1 reports the main results at T0.

Table 1

At T1, the DpDt max–ITBVI correlation was depressed in septic but not in nonseptic patients (P < 0.02), ITBVI improves in the nonseptic group (P < 0.05), and the ITBVI stroke volume index (SVI) was r = 0.49 in septic and r = 0.79 in nonseptic patients. At T2, DpDt max increased only in Group B (P < 0.05).

Conclusions

In early sepsis myocardial function is depressed as: DpDt max and SVI lay down at basal time and they do not increase during the study, SVV% improves, the DpDt max–ITBVI correlation is depressed during the fluid challenge and the cardiac response to dobutamine test is impaired.