Troponin T as myocardial ischemia marker to guide therapy with positive inotropes in septic shock patients

Introduction

Tissue ischemia and organ failure are considered to be main reasons for the high mortality in septic patients. In the past years therapy of septic shock has changed. The therapeutic goal is no longer a supranormal DO₂ (DO₂ > 600 ml/min/m²), but the sole therapy of low-output-failure (LOF) with positive inotropes to avoid myocardial ischemia [1,2]. It was investigated whether therapy guided by a myocardial ischemia marker troponin T is superior to the sole LOF therapy or the DO₂ guided therapy [3].

Methods

Thirty septic patients were included (following informed consent of the relatives) in this prospective randomized institutionally approved study. lf the patients achieved a DO₂ > 600 ml/min/m² by volume replacement alone they were excluded from the study. In case of required catecholamines, they were randomly allocated to three therapeutic groups: DO₂ (> 600 ml/min/m²); LOF (CI 2.5-3.0 l/min/m²); troponin T guided; CI > 2.5 l/min/m² and DO₂ > 600 ml/min/m² until the bedside troponin T test (semiquantitative rapid assay, Boehringer Inc) was positive with consecutive reduction of inotropic therapy to the prepositive level. Measurements were performed three times a day: hemodynamic and oxygen transport related variables, blood sampling, electrocardiogram and in case of no contraindications a transesophageal echocardiography. Statistics: Kruskal-Wallis-test.

Results

Basic patient characteristics did not differ between groups.

Conclusions

The myocardial ischemia marker troponin T differed significantly between groups. In the LOF and troponin T guided group lower maximal troponin T values were observed than in the DO₂ group. The ICU stay was significantly shorter in the troponin T guided group. Whether these results and the in tendency reduced mortality in the LOF and troponin T guided group are associated with these therapies require further investigation.

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