Сritical care echocardiography and transpulmonary thermodilution in patients with sepsis. Pilot study

Abstract

Introduction.The cardiac dysfunction in sepsis (septic cardiopathy) diagnosis is an actual problem. Objectives. To study the correspondence between the indicators obtained with сritical care echocardiography and transpulmonary thermodilution, and to assess their predictive significance in relation to the risk of mortality. Materials and methods. The study involved 25 patients aged 45 (31–68) years with abdominal sepsis or septic shock. The severity of the condition upon admission to the intensive care unit was 13 (11–16) points on the APACHE II scale, and 8 (6.5–9.5) points on the SOFA scale. Septic shock was diagnosed in 52 % of patients. Results. Cardiac index, stroke volume index, left ventricular ejection fraction and global cardiac ejection fraction, as well as heart filling volumes established by echocardiography and transpulmonary thermodilution were moderately correlated with each other (rho 0.408–0.538; p < 0.05). Dilation of the left ventricle (end-diastolic volume index 80–115 ml/m2) was detected in 16 % of patients. A decrease of the left ventricle ejection fraction (48–23 %) was registered in 24 % of cases. Transpulmonary thermodilution indices were not associated with a left ventricular ejection fraction value below 50 %. Neither left ventricular ejection fraction nor left ventricular filling volumes were predictors of adverse sepsis outcomes. The predictor of mortality was the cardiac function index determined with transpulmonary thermodilution (OR 0.3361; 95 % CI 0.1351–0.8363; p = 0.019), the value of which < 5.8 min–1 predicted mortality with sensitivity of 85.7 % and specificity of 72.2 % (AUC 0.817; p = 0.0057). Conclusions. Ultrasound assessment of cardiac activity with the calculation of left ventricular filling volumes and left ventricular ejection fraction should not be considered as a non-invasive alternative to transpulmonary thermodilution in patients with sepsis. The heart function index can diagnose abnormal heart function that increases the risk of mortality in abdominal sepsis.