BerbeeWalsh Department of Emergency Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States of America; Department of Emergency Medicine, Oregon Health and Science University, Portland, OR, United States of America.
BerbeeWalsh Department of Emergency Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States of America.
Am J Emerg Med. 2020 Dec;38(12):2653-2657. doi: 10.1016/j.ajem.2020.08.058. Epub 2020 Aug 27.
To describe changes in cardiac function throughout the course of resuscitation of patients with suspected septic shock.
Prospective observational cohort study of Point-of-Care Transthoracic Echocardiograms (TTE) obtained in Emergency Department (ED) patients with a presumed infectious cause of hypotension within one hour of initiating IV fluid resuscitation. Findings of this pre-resuscitation TTE were compared to mid-resuscitation TTE (obtained upon disposition from the ED), and post-resuscitation TTE (obtained after admission to hospital).
22 enrolled patients had a second TTE available for comparison to the initial, pre-resuscitation TTE. 12 patients had a mid-resuscitation TTE and 16 patients had a post-resuscitation TTE. We observed a high incidence of changes on TTE during the clinical course of resuscitation (14/22 [64%]). Patients who developed LV or RV dysfunction during resuscitation were more likely to require vasopressor infusion and ICU admission (Spearman's coefficients [95% CI] of 0.68 [0.36-0.86] and 0.47 [0.04;0.75] respectively). Development of RV dysfunction alone was associated with increased use of positive pressure ventilation and vasopressor infusion (Spearman's coefficients [95% CI] of 0.43 [0;0.72] and 0.47 [0.05,0.75] respectively).
Cardiac function changes assessed by TTE are common during the resuscitation of patients with septic shock. These changes likely reflect the underlying physiology of patients with septic shock and correlate with need for interventions and higher level of care. Further work is required to characterize these changes and to elucidate how to use these physiologic data to guide management.
描述疑似感染性休克患者复苏过程中心功能的变化。
前瞻性观察性队列研究，对疑似感染性低血压患者在开始静脉补液复苏后一小时内进行床边即时经胸超声心动图（TTE）检查。将这些预复苏 TTE 的结果与中复苏 TTE（从急诊科处置时获得）和复苏后 TTE（入院后获得）进行比较。
22 名入组患者有第二次 TTE 可与初始、预复苏 TTE 进行比较。12 名患者有中复苏 TTE，16 名患者有复苏后 TTE。我们观察到在复苏过程中 TTE 变化的发生率很高（14/22 [64%]）。在复苏过程中出现 LV 或 RV 功能障碍的患者更可能需要血管加压素输注和 ICU 入院（Spearman 系数[95%CI]分别为 0.68 [0.36-0.86]和 0.47 [0.04;0.75]）。仅 RV 功能障碍的发展与正压通气和血管加压素输注的使用增加相关（Spearman 系数[95%CI]分别为 0.43 [0;0.72]和 0.47 [0.05,0.75]）。
在感染性休克患者的复苏过程中，TTE 评估的心脏功能变化很常见。这些变化可能反映了感染性休克患者的潜在生理学，并与干预和更高水平护理的需求相关。需要进一步的工作来描述这些变化，并阐明如何使用这些生理数据来指导管理。
