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Systolic-dicrotic notch pressure difference can identify tachycardic patients with septic shock at risk of cardiovascular decompensation following pharmacological heart rate reduction.
- Source :
-
British journal of anaesthesia [Br J Anaesth] 2020 Dec; Vol. 125 (6), pp. 1018-1024. Date of Electronic Publication: 2020 Jul 18. - Publication Year :
- 2020
-
Abstract
- Background: During sepsis, heart rate (HR) reduction could be a therapeutic target, but identification of responders (non-compensatory tachycardia) and non-responders (compensatory for 'fixed' stroke volume [SV]) is challenging. We tested the ability of the difference between systolic and dicrotic pressure (SDP <subscript>difference</subscript> ), which reflects the coupling between myocardial contractility and a given afterload, in discriminating the origin of tachycardia.<br />Methods: In this post hoc analysis of 45 patients with septic shock with persistent tachycardia, we characterised features of haemodynamic response focusing on SDP <subscript>difference</subscript> , classifying patients according to variations in arterial dP/dt <subscript>max</subscript> after 4 h of esmolol administration to maintain HR <95 beats min <superscript>-1</superscript> . A cut-off value of 0.9 mm Hg ms <superscript>-1</superscript> was used for group allocation.<br />Results: After reducing HR, arterial dP/dt <subscript>max</subscript> remained above the cut-off in 23 patients, whereas it decreased below the cut-off in 22 patients (from 0.99 [0.37] to 0.63 [0.16] mm Hg ms <superscript>-1</superscript> ; mean [SD], P<0.001). At baseline, patients with decreased dP/dt <subscript>max</subscript> after esmolol had lower SDP <subscript>difference</subscript> than those with higher dP/dt <subscript>max</subscript> (40 [19] vs 53 [16] mm Hg, respectively; P=0.01). The SDP <subscript>difference</subscript> remained unchanged after esmolol in the higher dP/dt <subscript>max</subscript> group (49 [16] mm Hg), whereas it decreased significantly in patients with lower dP/dt <subscript>max</subscript> (29 [11] mm Hg; P<0.001). In the latter, the HR reduction resulted in a significant cardiac output reduction with unchanged SV, whereas in patients with higher dP/dt <subscript>max</subscript> SV increased (from 48 [12] to 67 [14] ml; P<0.001) with maintained cardiac output.<br />Conclusions: A decrease in SDP <subscript>difference</subscript> could discriminate between compensatory and non-compensatory tachycardia, revealing a covert loss of myocardial contractility not detected by conventional echocardiographic parameters and deteriorating after HR reduction with esmolol.<br />Clinical Trial Registration: NCT02188888.<br /> (Copyright © 2020 British Journal of Anaesthesia. Published by Elsevier Ltd. All rights reserved.)
- Subjects :
- Adrenergic beta-Antagonists therapeutic use
Adult
Aged
Arterial Pressure
Blood Pressure drug effects
Cardiac Output drug effects
Echocardiography
Female
Heart Failure diagnostic imaging
Humans
Male
Middle Aged
Myocardial Contraction drug effects
Norepinephrine therapeutic use
Propanolamines therapeutic use
Prospective Studies
Shock, Septic diagnostic imaging
Tachycardia diagnostic imaging
Tachycardia drug therapy
Tachycardia etiology
Vasoconstrictor Agents therapeutic use
Heart Failure physiopathology
Heart Rate drug effects
Shock, Septic physiopathology
Tachycardia physiopathology
Subjects
Details
- Language :
- English
- ISSN :
- 1471-6771
- Volume :
- 125
- Issue :
- 6
- Database :
- MEDLINE
- Journal :
- British journal of anaesthesia
- Publication Type :
- Academic Journal
- Accession number :
- 32690246
- Full Text :
- https://doi.org/10.1016/j.bja.2020.05.058