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Is myocardial adrenergic responsiveness depressed in human septic shock?

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Abstract

Objective

To assess left ventricular (LV) contractile function and adrenergic responsiveness in septic patients.

Methods

We used echocardiographically defined fractional area of contraction (FAC), and LV area to end-systolic arterial pressure estimates of end-systolic elastance (E'es) and its change in response to dobutamine (5 μg/kg/min) in 10 subjects in septic shock admitted to an intensive care unit of an academic medical center. Subjects were studied on admission and again at both 5 days and 8–10 days after admission.

Results

Three of the 10 subjects died as a result of their acute process, while the others were discharged from hospital. Nine out of 10 subjects required intravenous vasopressor therapy on day 1, while only 1 of 9 subjects required vasopressor support at day 5. LV end-diastolic area (EDA) increased from day 1 to day 5 and days 8–10 (p < 0.05), but neither FAC nor E'es was altered by time (EDA 15.7 ± 5.8, 21.4 ± 5.1, and 19.4 ± 5.6 cm2; FAC 0.46 ± 0.19, 0.50 ± 0.20, and 0.48 ± 0.15%; E'es 21.6 ± 12.6, 23.2 ± 8.5, and 19.2 ± 6.3 mmHg/cm2, mean ± SD, for days 1, 5 and 8–10 respectively). Although dobutamine did not alter E'es on day 1 or day 5, E'es increased in all of the 5 subjects studied on days 8–10 (p < 0.05).

Conclusions

Adrenergic hyporesponsiveness is present in septic shock and persists for at least 5 days into recovery, resolving by days 8–10 in survivors.

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Authors and Affiliations

  1. Cochin-Saint Vincent de Paul Hospital and Paris Descartes University, Paris, France

    Alain Cariou, Michael R. Pinsky, Mehran Monchi, Ivan Laurent, Christophe Vinsonneau, Jean-Daniel Chiche, Julien Charpentier & Jean-François Dhainaut

  2. Department of Critical Care Medicine, University of Pittsburgh, 606 Scaife Hall, 3550 Terrace St., 15261, Pittsburgh, PA, USA

    Michael R. Pinsky

Authors
  1. Alain Cariou
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  2. Michael R. Pinsky
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  3. Mehran Monchi
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  4. Ivan Laurent
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  5. Christophe Vinsonneau
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  6. Jean-Daniel Chiche
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  7. Julien Charpentier
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  8. Jean-François Dhainaut
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Corresponding author

Correspondence to Michael R. Pinsky.

Additional information

Dr. Pinsky was a Professeur Associé at Cochin Hospital and Paris Descartes University.

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Cariou, A., Pinsky, M.R., Monchi, M. et al. Is myocardial adrenergic responsiveness depressed in human septic shock?. Intensive Care Med 34, 917–922 (2008). https://doi.org/10.1007/s00134-008-1022-y

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  • DOI: https://doi.org/10.1007/s00134-008-1022-y

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