Dynamic left intraventricular obstruction in patients with septic shock: pathogenetic role and prognostic implications

Elhadidy, Samir; Rafea, Moustafa; Fawzy, Samar M.; El-Azab, A.S.

doi:10.4103/roaic.roaic_40_19

Cited by 5 publications

(6 citation statements)

References 2 publications

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“…However, when patients were regrouped according to the LVOT peak velocity, the length of stay was significantly shorter in the high peak velocity group. Our study differs from the literature in this respect [6,7]. We think that the reason for this situation may be the shorter length of stay in the ICU due to the higher mortality rate in patients with higher LVOT peak velocity.…”

Section: Discussioncontrasting

confidence: 82%

“…In a recent study with 40 patients with septic shock, the LVOT peak velocity measurement was observed to be significantly decreased following bolus fluid infusion at a rate of 30 cc/kg, and the presence of LVOT obstruction in a patient with septic shock suggested severe hypovolemia [ 7 ]. In our study, we found no significant difference between the LVOT peak velocities between patients with and without fluid deficit according to bedside caval measurements.…”

Section: Discussionmentioning

confidence: 99%

“…In both the studies of Chauvet et al and Elhadidy et al, the overall and 28th-day mortality rates were higher in patients with increased LVOT peak velocity [ 6 , 7 ]. Also, 90 cm/s was the cut-off value in both studies.…”

Section: Discussionmentioning

confidence: 99%

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The Role of Left Ventricular Outflow Tract Peak Velocity Measurement in Patients With Sepsis and Septic Shock

Serin¹,

Özlüer²,

Kıy³

et al. 2022

Cureus

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To determine whether left ventricular outflow tract peak velocity is useful for the prediction of mortality in the early phase of sepsis or septic shock. Materials and methodsPatients who were hospitalized in the emergency intensive care unit (ED-ICU) with the diagnosis of sepsis or septic shock were consecutively enrolled into two groups (sepsis and septic shock groups) between January 2020 to February 2021. Patients who are pregnant and ≤18 years old were excluded. Demographics, vital parameters, the presence of mechanical ventilation, and vasopressor/inotropic support with the doses of the drugs used were recorded. Ultrasonographic measurements included bedside caval indexes and left ventricular outflow tract (LVOT) peak velocity measurements. The primary outcome was in-hospital and 28th-day mortality. ResultsA total of 116 patients with a median age of 72.5 (27 to 96) years were enrolled. Sixty-eight (58.6%) patients were male. According to a receiver operating characteristic (ROC) curve analysis, 75 cm/s was determined as a cut-off value to determine the efficacy of LVOT peak velocity measurement for discriminating septic shock from sepsis and predicting 28-day and in-hospital mortality. The patients were then regrouped as 54 (46.5%) patients in low and 62 (53.5%) patients in high-velocity groups according to the cut-off value. Both inhospital and 28th-day mortality rates were significantly different between these groups (p<0.001). ConclusionLeft ventricular outflow tract peak velocity measurement may be a useful adjunct for the prediction of mortality in septic patients. Vasopressors and volume status of the patient do not affect LVOT peak velocity measurements.

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Section: Discussioncontrasting

confidence: 82%

Section: Discussionmentioning

confidence: 99%

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The Role of Left Ventricular Outflow Tract Peak Velocity Measurement in Patients With Sepsis and Septic Shock

Serin¹,

Özlüer²,

Kıy³

et al. 2022

Cureus

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“…In our study, there was a significantly higher were fluid responsive (70%) but There was no significant difference between both groups as regards the incidence of fluid responsiveness (p value: 0.271) (12) Regarding the mortality, our patients with left ventricular obstruction had a significantly higher mortality rate 72.2% versus 34.4% in patients without obstruction (P-value=0.010).…”

Section: Resultscontrasting

confidence: 49%

Assessment of dynamic left ventricular outflow track obstruction as fluid responsiveness marker in mechanically ventilated septic patients

Maraghi

ElHossainy

Samy

2022

Egyptian Journal of Medical Research

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Background: Sepsis is life-threatening organ dysfunction caused by a dysregulated host response to infection. Similar to poly trauma, acute myocardial infarction, or stroke, early identification and appropriate management in the initial hours after sepsis develops improves outcomes. In a patient with septic shock, a fluid challenge will cause an increase in stroke volume; according to the Frank-Starling curve [1] .Relative hypovolemia has been described in the setting of septic shock. However, only 50 % of patients with hemodynamic instability are fluid responsive [2] . Purpose: Assessment of Fluid responsiveness in ventilated septic shock patients according to presence of LVOT obstruction and to judge the power of prediction of other hemodynamic parameters. Methods: A prospective observational study was carried out on 50 adult mechanically ventilated patients with septic shock. Two sets of measurements were performed before and immediately after volume expansion. Cardiac output (CO), stroke volume (SV), IVC distensibility index (dIVC), LVOT velocity ( m/s ,Mean and peak pressure gradient (mmHg) were measured by transthoracic echocardiography. Fluid challenge responders were defined as patients whose cardiac output was increased ≥15 %. The area under the receiver operating characteristic curve (AUC) was compared for each predictive parameter. Results:During the study period, LVOT obstruction was found in 18 patients (36 %). Mortality rate at 60 days was found to be higher in patients with LVOT than in patients without LVOT obstruction (75% versus 25%, p < 0.01). Around 90 % of patients with LVOT obstruction were fluid responders versus 60 % from patient without LVOT obstruction (P-value=0.04). IVC distensibility index predicts fluid responsiveness at a cutoff point 17% with a sensitivity 88% and specificity 83 %( pvalue < 0.001 and AUC= 0.934) Conclusions: LVOT obstruction in the early phase of septic shock is not rare (more than one third of septic shock patients) and is associated with a high mortality rate.Patients who have LVOT, are more fluid responsive than whom have no LVOT. IVC distensibility index carries important baseline parameters that could predict fluid responsiveness in mechanically ventilated patients with septic shock

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“…The incidence is probably higher than expected, ranging from 20% to 30%. 6 , 7 Dynamic LVOTO is related to higher mortality 8 and fluid responsiveness. Hypovolemia is 1 of the main etiological factors, that is, why dynamic LVOTO usually is fluid-responsive.…”

Section: Discussionmentioning

confidence: 99%

Beta Blockers as Salvage Treatment in Refractory Septic Shock Complicated With Dynamic Left Ventricular Outflow Tract Obstruction: A Rare Case Presentation

Pablo

Achilleus

Veras

et al. 2021

Journal of Investigative Medicine High Impact Case Reports

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Hypotension is the main finding in patients admitted to an intensive care unit (ICU) with the diagnosis of septic shock and it is related to worse outcomes. In these patients, several underlying causes of hypotension may co-exist, including vasoplegia, hypovolemia, drug-mediated venodilation, or myocardial dysfunction. Nowadays, echocardiography has been positioned as an essential tool in any ICU set to assess fluid status, ventricular ejection fraction, or any other myocardial complications. The high sympathetic tone in severely ill patients, in addition to high doses of adrenergic drugs often needed, may provoke a hypercontractile cardiac state. In the basis of our experience, we present a case of a patient with refractory septic shock and severe hemodynamic collapse, refractory to vasopressors with concomitant respiratory deterioration due to dynamic left ventricular outflow tract obstruction (LVOTO). Transesophageal echocardiography (TOE) was used to assess hemodynamic status and to guide treatment. A critical response to intravenous β-blockers was seen, with a dramatic decrease in vasopressor dosage and respiratory support.

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Dynamic left intraventricular obstruction in patients with septic shock: pathogenetic role and prognostic implications

Cited by 5 publications

References 2 publications

The Role of Left Ventricular Outflow Tract Peak Velocity Measurement in Patients With Sepsis and Septic Shock

The Role of Left Ventricular Outflow Tract Peak Velocity Measurement in Patients With Sepsis and Septic Shock

Assessment of dynamic left ventricular outflow track obstruction as fluid responsiveness marker in mechanically ventilated septic patients

Beta Blockers as Salvage Treatment in Refractory Septic Shock Complicated With Dynamic Left Ventricular Outflow Tract Obstruction: A Rare Case Presentation

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