Right ventricular failure in septic shock: characterization, incidence and impact on fluid responsiveness.
Central venous pressure
Critical care echocardiography
Fluid responsiveness
Right ventricular failure
TAPSE
Journal
Critical care (London, England)
ISSN: 1466-609X
Titre abrégé: Crit Care
Pays: England
ID NLM: 9801902
Informations de publication
Date de publication:
01 11 2020
01 11 2020
Historique:
received:
04
08
2020
accepted:
14
10
2020
entrez:
2
11
2020
pubmed:
3
11
2020
medline:
25
6
2021
Statut:
epublish
Résumé
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.
Identifiants
pubmed: 33131508
doi: 10.1186/s13054-020-03345-z
pii: 10.1186/s13054-020-03345-z
pmc: PMC7603714
doi:
Types de publication
Journal Article
Multicenter Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
630Commentaires et corrections
Type : CommentIn
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