A follow-up study of severe sepsis/septic shock patients using echocardiography

Objective

To follow-up severe sepsis/septic shock patients using echocardiographic parameters.

Setting and design

A prospective study in a 14-bed medical/surgical ICU.

Materials and methods

In septic patients the following parameters were obtained: left ventricular (LV) telediastolic dimensions, LV shortening fraction (LVSF), cardiac output (CO) by analysis of pulsed-wave Doppler at the LV outflow tract and inferior vena cava (IVC) evaluation (maximum and minimum dimensions and IVC index). Other parameters were also obtained: age, sex, severity scores (APACHE II, SAPS II, SOFA, and MODS), serum lactate levels, arterial pressure, heart rate, central venous pressure, and need for renal replacement techniques. All data were obtained on the first day of ICU admittance, and at days 2, 3, 5, and then each 5 days. Only patients with three or more evaluations were included. The data analysis was performed by dividing the patients into two groups: survivors (group 1) and nonsurvivors (group 2).

Results

Twenty-three patients were enrolled. Thirteen patients died (group 2, 56.5%). In group 2 we observed a progressive, but statistically nonsignificant, increase in CO, severity scores, and serum lactate. The IVC index decreased in group 2 over the study time with statistical significance (P < 0.05). The main feature of patients in group 1 was a decrease in CO, severity scores and a statistically significant increase in the IVC index. LV dimensions changed in both groups, always not significantly and not linked to a particular outcome or in a consistent manner. Several patients presented with a decrease in LVSF at any time during the study, not linked with any particular outcome, or to changes in CO.

Conclusion

The fatal course of severe sepsis/septic shock was characterized by a progressive increase in CO, severity scores and serum lactate, although lacking statistical significance. A progressive decrease in the IVC index was statistically significant in the nonsurvivors group. Changes in LV dimension (enlargement) or LVSF were not a constant feature, and we were not able to link these changes to any particular clinical outcome.