2008, Number 2
Septic shock reanimation based on ventricular-arterial coupling vs pulmonary artery catheter-derived variables
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ABSTRACTIntroduction: Mortality from septic shock (SS) remains elevated. In selected patients (p) [sinusal rhythm and controlled mechanical ventilation (MV)] an algorithm based in hemodynamic functional monitoring could be useful.
Methods: In an ICU, from january 2006 to january 2007 SS patients were selected and randomized in two groups: the 1rs one was reanimated following the pulmonary artery catheter (PAC) protocol suggested by Vincent, while the 2nd group was reanimated using the Pinsky’s protocol (PP).
Results: 35 p were included: 20 in the PAC group (PG) and 15 in the PP, were 5 p was eliminated. For PG, median age was 71 (59-75) years, APACHE II 28 (25-30) points, SOFA 12 (12-14) points, mean arterial pressure (MAP) 64 (60-65) mmHg, central venous pressure (CVP) 13.5 (11.2-15) mmHg, cardiac index (CI) 2.2 (1.8-2.4) L/min/m2, SvO2 63 (61-64) %. In PP: median age was 68 (45-79) years, APACHE II 27 (25-28) points, SOFA 12 (10-14) points, MAP 60 (60-65) mmHg, CVP 10 (8-15) mmHg, CI 2.0 (2.0-2.1) L/min/m2, SvO2 60 (57-60) %. Time between SS diagnosis and algorithm implementation was: for PG 5 (4-6) hours (h) and 8 (8-9.2) h in PP (P ‹ 0.005). Goals were achieved in the PG in 8 (7.2-9) h, and in 5 (4-6) h in PP (P = 0.03). After 24 hours: APACHE II improved from 28 to 21 points (P = 0.02) and SOFA from 12 to 10 points (P = 0.03) in PP, in the PG remained without changes. Fluids hourly required after 24 hours was PG 200 (100-200) mL and PP 250 (250-500) mL (P ‹ 0.005). Mortality in the PG was 66%, while in PP was 33.3% (P = 0.06).
Conclusion: The reanimation goals were firstly achieved in the group of Ventricular arterial coupling protocol with hemodynamic functional monitoring. Mortality showed no statistical difference.
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