Physiologic cardiovascular studies among patients with treated septic shock and persistent hyperlactatemia

Authors

  • Dujrath Somboonviboon Division of Pulmonary and Critical care Medicine, Phramongkutklao Hospital, Bangkok, Thailand
  • Waraporn Tiyanon Division of Cardiology, Department of Medicine, Phramongkutklao Hospital, Bangkok, Thailand.
  • Petch Wacharasint Division of Pulmonary and Critical care Medicine, Phramongkutklao Hospital, Bangkok, Thailand

DOI:

https://doi.org/10.54205/ccc.v29i.252072

Keywords:

Sepsis, Ventriculo-arterial coupling, Venous return, Lactate

Abstract

Background: To study effects of increasing vasopressor dosage and fluid resuscitation on ventriculoarterial (VA) coupling and venous return (VR)-related parameters in resuscitated normotensive septic shock patients with persistent hyperlactatemia.

Methods: We performed a prospective experimental study in patients with septic shock who was admitted to medical intensive care unit and still had hyperlactatemia even received initial resuscitation to maintain mean arterial pressure (MAP) >65 mmHg. All patients received incremental dose of norepinephrine (NE) to increased MAP, then NE was titrated to baseline dosage and waited for 15 mins, then fluid bolus was given. VA coupling-related parameters [arterial elastance (Ea), left ventricular end-systolic elastance (Ees), left ventricular stroke work (SW), potential energy (PE), stroke volume (SV), and Ea/Ees], and VR-related parameters [central venous pressure (CVP), mean systemic pressure analogue (Pmsa), venous return pressure (Pvr)] were measured at 4 time points including pre-increased NE phase, post-increased NE phase, pre-fluid bolus phase, and post-fluid bolus phase. Primary outcome was average of Ea/Ees. Secondary outcomes were differences in VA coupling-related parameters and VR-related parameters between pre- vs. post- interventions.

Results: All 20 patients were normotensive [MAP 74 (66-80) mmHg] with elevated blood lactate [2.7 (2.4-3.6) mmol/L] at enrollment. Average Ea/Ees was 0.89 (0.61-1.16). Compared to pre-increased NE phase, post-increased NE phase had significantly higher MAP, CVP, SV, SW, PE, Pmsa, and Pvr. Likewise, compared to pre-fluid bolus phase, post-fluid bolus raised MAP, CVP, SV, Ees, SW, Pmsa, and Pvr significantly. No difference in Ea/Ees compared between before- vs. after- received both interventions.

Conclusions: In resuscitated normotensive septic shock patients with persistent hyperlactatemia, we found an average Ea/Ees of 0.89. Increasing NE dosage or fluid bolus increased most of VA coupling-related parameters and VR-related parameters, but not Ea/Ees. Further large study is warranted to validate these findings.

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Published

2021-10-20

How to Cite

1.
Somboonviboon D, Tiyanon W, Wacharasint P. Physiologic cardiovascular studies among patients with treated septic shock and persistent hyperlactatemia . Clin Crit Care [Internet]. 2021 Oct. 20 [cited 2022 Jan. 23];29:2021:e0006. Available from: https://he02.tci-thaijo.org/index.php/ccc/article/view/252072

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Original Articles