Dynamics of ventriculo-arterial coupling and peripheral tissue perfusion during early resuscitation of septic shock
Authors' conclusion
Although LVAC improvement was associated with recovery of peripheral perfusion in some patients, and its deterioration with CRT prolongation in others, this relationship proved to be weak. Indeed, inconsistent CRT behavior among persistently coupled or uncoupled patients, and the heterogeneous response to resuscitative interventions suggest peripheral perfusion often evolves independently of energy transmitted from the heart to proximal arterial tree.
Study context
- Population
- Adult patients within 4-h of meeting Sepsis-3.0 septic shock criteria, during early resuscitationpatients included
- Participants
- Eighty-four patients
- Exposure
- Variations in capillary refill time (CRT) between baseline and 6-h across four groups defined by left ventriculo-arterial coupling (LVAC) evolution; CRT before/after fluid loading and/or dobutamine according to pre-intervention LVAC status
- Outcome
- CRT variation between baseline and 6-h
- Follow-up
- 6-h
Main finding
As reported in the abstract
| Group | Value | p |
|---|---|---|
| Uncoupled-to-coupled | −33.8 (range as printed −53.1–-1.2) % | p = 0.013 |
| Coupled-to-uncoupled | 17.5 (range as printed 7.1–31.3) % | p = 0.013 |
Value
p
- Four LVAC evolution groups: P = 0.013 — differed significantly among groups
Observational data: associations, not effects.
Further findings
CRT change after interventions in initially uncoupled patients
- CRT after dobutamine
- −26.2%, p = 0.007
- CRT after fluid loading
- −9.5%, p = 0.656
- Stroke volume after fluids
- +14.0%, p = 0.021
- Stroke volume after dobutamine
- +14.2%, p < 0.001
- Thirty-one fluid loads and thirty-two inotrope interventions analyzed
CRT change after interventions in patients already coupled
- CRT did not change after either intervention
Original publication
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