Intensive Care Unit, Assistance Publique-Hôpitaux de Paris, University Hospital Ambroise Pare, Boulogne Billancourt, France.
Faculty of Medicine Simone Veil, Saint Quentin en Yvelines, France.
Crit Care. 2020 Nov 1;24(1):630. doi: 10.1186/s13054-020-03345-z.
Incidence of right ventricular (RV) failure in septic shock patients is not well known, and tricuspid annular plane systolic excursion (TAPSE) could be of limited value. We report the incidence of RV failure in patients with septic shock, its potential impact on the response to fluids, as well as TAPSE values.
Ancillary study of the HEMOPRED prospective multicenter study includes patients under mechanical ventilation with circulatory failure.
This is a multicenter intensive care unit study PATIENTS: Two hundred and eighty-two patients with septic shock were analyzed. Patients were classified in three groups based on central venous pressure (CVP) and RV size (RV/LV end-diastolic area, EDA). In group 1, patients had no RV dilatation (RV/LVEDA < 0.6). In group 2, patients had RV dilatation (RV/LVEDA ≥ 0.6) with a CVP < 8 mmHg (no venous congestion). RV failure was defined in group 3 by RV dilatation and a CVP ≥ 8 mmHg. Pulse pressure variation (PPV) was systematically recorded.
None.
In total, 41% of patients were in group 1, 17% in group 2 and 42% in group 3. A correlation between RV size and CVP was only observed in group 3. Higher RV size was associated with a lower response to passive leg raising for a given PPV. A large overlap of TAPSE values was observed between the 3 groups. 63.5% of patients with RV failure had a normal TAPSE.
RV failure, defined by critical care echocardiography (RV dilatation) and a surrogate of venous congestion (CVP ≥ 8 mmHg), was frequently observed in septic shock patients and negatively associated with response to a fluid challenge despite significant PPV. TAPSE was unable to discriminate patients with or without RV failure.
脓毒性休克患者右心室（RV）衰竭的发生率尚不清楚，三尖瓣环平面收缩期位移（TAPSE）的价值可能有限。我们报告了脓毒性休克患者 RV 衰竭的发生率、其对液体反应的潜在影响以及 TAPSE 值。
机械通气伴循环衰竭患者的 HEMOPRED 前瞻性多中心研究的辅助研究。
这是一项多中心重症监护病房研究。
分析了 282 例脓毒性休克患者。根据中心静脉压（CVP）和 RV 大小（RV/LV 舒张末期面积，EDA），将患者分为三组。在第 1 组中，患者没有 RV 扩张（RV/LVEDA<0.6）。在第 2 组中，患者有 RV 扩张（RV/LVEDA≥0.6），CVP<8mmHg（无静脉充血）。在第 3 组中，RV 扩张和 CVP≥8mmHg 定义为 RV 衰竭。系统记录脉压变异（PPV）。
无。
共有 41%的患者在第 1 组，17%在第 2 组，42%在第 3 组。仅在第 3 组中观察到 RV 大小与 CVP 之间存在相关性。在给定的 PPV 下，较大的 RV 大小与被动抬腿的反应降低相关。在 3 组之间观察到 TAPSE 值的大量重叠。63.5%的 RV 衰竭患者 TAPSE 正常。
根据重症监护超声心动图（RV 扩张）和静脉充血的替代指标（CVP≥8mmHg）定义的 RV 衰竭在脓毒性休克患者中经常观察到，尽管有明显的 PPV，但与液体挑战的反应呈负相关。TAPSE 无法区分有或没有 RV 衰竭的患者。
