Pulmonary artery occlusion pressure overestimates left ventricular preload in patients with sepsis.
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It is important to maintain adequate preload in the management of patients with sepsis. Assessment of left ventricular (LV) preload using pulmonary artery occlusion pressure (PAOP) has become a standard method in critical care settings since the Swan-Ganz catheter was introduced. The aim of the present study was to determine if PAOP could be a reliable index of LV preload in patients with sepsis. Hemodynamic evaluation by using pulmonary artery flotation catheters was performed on 11 patients with documented sepsis (sepsis group). Left ventricular dimensions were recorded simultaneously by using echocardiography. As a control group 16 acutely traumatized patients without any evidence of systemic infection were enrolled. PAOP in the sepsis group was significantly higher than that in the control group (p<0.05, Student's t-test) The values for stroke volume index (SVI) and LV end-diastolic volume index (EDVI) showed no significant difference between the groups. The indices for LV systolic function including ejection fraction, mean velocity of circumferential fiber shortening, and the ratio of systolic blood pressure to left ventricular end-systolic dimension remained within normal range or somewhat increased in both groups. The simple linear regression equation showed that SVI did not depend on PAOP, but did depend on the EDVI with statistical significance (p<0.01, in both groups). While EDVI was a good predictor of SVI in the presence of good LV systolic function, the dissociation between PAOP and EDVI suggests the risk of overestimation of LV preload based on PAOP in patients with sepsis. In the management of sepsis, therefore, an alternative way to evaluate LV preload such as echocardiography or radionuclear angiography should be considered.
- 一般社団法人 日本救急医学会の論文
一般社団法人 日本救急医学会 | 論文
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