1Intensive Care Unit, Centre Hospitalier Versailles, Le Chesnay, France. 2Medical Intensive Care Unit, Cochin University Hospital, AP-HP, Paris, France. 3Paris Descartes University, Sorbonne Paris Cité, Medical School, Paris, France. 4INSERM, U970, Paris Cardiovascular Research Center, European Georges Pompidou Hospital, Paris, France. 5Emergency Department, Groupe Hospitalier Broca Cochin Hotel-Dieu, AP-HP, Paris, France.
Crit Care Med. 2015 Dec;43(12):2597-604. doi: 10.1097/CCM.0000000000001303.
To investigate the contribution of endotoxemia to the severity of postcardiac arrest shock.
A prospective monocentric study.
A tertiary hospital in Paris, France.
Patients admitted in our ICU after a successfully resuscitated out-of-hospital cardiac arrest.
None.
Endotoxin measurement was performed in the 12 hours following return of spontaneous circulation using the endotoxin activity assay. Endotoxin level was classified as low (< 0.4 endotoxin activity), intermediate (0.4 to < 0.6 endotoxin activity), or high (≥ 0.6 endotoxin activity) according to manufacture guidelines. Severity of shock was assessed by the vasopressor-free days and by the mean daily dose of vasopressor to insure a mean arterial pressure of 65-75 mm Hg. Among 92 patients included in the study, 60 presented a postcardiac arrest shock. Endotoxemia level was higher in patients with postcardiac arrest shock. Among these patients, by multivariate linear regression, high endotoxin class (adjusted estimate -2.0; 95% CI, -3.90 to -0.11), public place of cardiac arrest (adjusted estimate, 1.47; 95% CI, 0.007 to 2.93), and time to return of spontaneous circulation (adjusted estimate -0.08; 95% CI, -0.13 to -0.03) were independently associated with the number of vasopressor-free days. Furthermore, high endotoxin class (adjusted estimate, 97.95; 95% CI, 20.5 to 175.4) and a nonshockable rhythm (adjusted estimate, 59.9; 95% CI, 6.2 to 113.7) were the sole factors independently associated with the mean daily dose of vasopressors.
In patients successfully resuscitated from cardiac arrest with a postcardiac arrest shock, high level of endotoxemia is independently associated with duration of postcardiac arrest shock and the amount of vasopressive drugs. Whether treatment targeting endotoxemia could be beneficial in the management of postcardiac arrest shock needs to be studied in further randomized controlled studies.
研究内毒素血症对心脏骤停后休克严重程度的影响。
前瞻性单中心研究。
法国巴黎的一家三级医院。
在我院 ICU 中接受成功复苏的院外心脏骤停患者。
无。
使用内毒素活性测定法在自主循环恢复后 12 小时内测量内毒素。根据制造商的指南，将内毒素水平分为低（<0.4 内毒素活性）、中（0.4 至<0.6 内毒素活性）或高（≥0.6 内毒素活性）。休克的严重程度通过无血管加压药天数和保证平均动脉压在 65-75mmHg 的平均每日血管加压药剂量来评估。在纳入的 92 例患者中，有 60 例出现心脏骤停后休克。心脏骤停后休克患者的内毒素水平更高。在这些患者中，通过多元线性回归分析，高内毒素组（调整估计值-2.0；95%CI，-3.90 至-0.11）、公共场心脏骤停（调整估计值，1.47；95%CI，0.007 至 2.93）和自主循环恢复时间（调整估计值，-0.08；95%CI，-0.13 至-0.03）与无血管加压药天数独立相关。此外，高内毒素组（调整估计值，97.95；95%CI，20.5 至 175.4）和不可电击节律（调整估计值，59.9；95%CI，6.2 至 113.7）是与血管加压药每日剂量独立相关的唯一因素。
在成功复苏的心脏骤停伴有心脏骤停后休克的患者中，高水平的内毒素血症与心脏骤停后休克的持续时间和血管加压药物的使用量独立相关。在内毒素血症靶向治疗是否能有益于心脏骤停后休克的管理方面，还需要进一步的随机对照研究来证实。
