%0 Journal Article
%T Diastolic dysfunction and mortality in early severe sepsis and septic shock: a prospective, observational echocardiography study
%A Samuel M Brown
%A Joel E Pittman
%A Eliotte L Hirshberg
%A Jason P Jones
%A Michael J Lanspa
%A Kathryn G Kuttler
%A Sheldon E Litwin
%A Colin K Grissom
%J Critical Ultrasound Journal
%D 2012
%I BioMed Central
%R 10.1186/2036-7902-4-8
%X In this prospective, observational study conducted in two intensive care units at a tertiary care hospital, 78 patients (age 53.2£¿¡À£¿17.1£¿years; 51% females; mean APACHE II score 23.3£¿¡À£¿7.4) with severe sepsis or septic shock underwent TTE within 6£¿h of ICU admission, after 18 to 32£¿h, and after resolution of shock. Left ventricular (LV) diastolic dysfunction was defined according to modified American Society of Echocardiography 2009 guidelines using E, A, and e¡¯ velocities; E/A and E/e¡¯; and E deceleration time. Systolic dysfunction was defined as an ejection fraction£¿<£¿45%.Twenty-seven patients (36.5%) had diastolic dysfunction on initial echocardiogram, while 47 patients (61.8%) had diastolic dysfunction on at least one echocardiogram. Total mortality was 16.5%. The highest mortality (37.5%) was observed among patients with grade I diastolic dysfunction, an effect that persisted after controlling for age and APACHE II score. At time of initial TTE, central venous pressure (CVP) (11+/- 5£¿mmHg) did not differ among grades I-III, although patients with grade I received less intravenous fluid.LV diastolic dysfunction is common in septic patients. Grade I diastolic dysfunction, but not grades II and III, was associated with increased mortality. This finding may reflect inadequate fluid resuscitation in early sepsis despite an elevated CVP, suggesting a possible role for TTE in sepsis resuscitation.Cardiovascular dysfunction is a central component of the multiple organ dysfunction syndrome, an often fatal sequela of severe sepsis and septic shock. Although most research on cardiovascular dysfunction in septic shock has focused on left ventricular (LV) systolic dysfunction [1-5], LV diastolic dysfunction also occurs [6,7]. In sepsis, cardiac dysfunction reflects both intrinsic dysfunction and the adequacy of loading conditions, including both preload and afterload. Intrinsic LV diastolic dysfunction may make patients more sensitive to volume expansion interventions, ofte
%K Sepsis
%K echocardiography
%K Diastolic dysfunction
%K Shock
%U http://www.criticalultrasoundjournal.com/content/4/1/8