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Archived Comments for: Prediction of hospital outcome in septic shock: a prospective comparison of tissue Doppler and cardiac biomarkers

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  1. Echocardiographic prognostic markers may be institution specific

    Stephen Woodford, Brisbane Waters Private Hospital

    29 March 2010

    Diastolic dysfunction in established sepsis signifies cardiac involvement in the septic process, but its value as a prognostic marker is markedly subject to the methodology of sepsis management. If the haemodynamic endpoints of the Rivers' Protocol(MAP 65,CVP 10-12) are the goal of therapy, rather than age and gender specific haemodynamic endpoints that reflect values in health, diastolic dysfunction will be commoner and more lethal. Proving the value of echocardiographic markers of diastolic dysfunction would require age and gender specific subgroup analysis, and require considerable haemodynamic data to demonstrate comparability. Perhaps this will be forthcoming in the future.

    Competing interests

    I have been exploring a graphical method for diagnosis and therapy in anaesthesia and critical care, which I call "Haemodynamic Mapping". It is clear from data in circa 150 patients that the circulation and cardiac performance change inexorably and progressively from the age of 60 in women and circa 70 yrs in men. This study has insufficient information to draw valid conclusions