Optimizing left ventricular-arterial coupling during the initial resuscitation in septic shock – a pilot prospective randomized study

作者：Xiaoyang Zhou, Yiqin Zhang, Jianneng Pan, Yang Wang, Hua Wang, Zhaojun Xu, Bixin Chen, Caibao Hu · 发表于：BMC Anesthesiology · 年份：2022 · DOI：10.1186/s12871-021-01553-w · 被引用次数：19 · 研究领域：Cardiovascular Function and Risk Factors、Sepsis Diagnosis and Treatment、Hemodynamic Monitoring and Therapy

BACKGROUND: Left ventricular-arterial coupling (VAC), defined as the ratio of effective arterial elastance (Ea) to left ventricular end-systolic elastance (Ees), has been extensively described as a key determinant of cardiovascular work efficacy. Previous studies indicated that left ventricular-arterial uncoupling was associated with worse tissue perfusion and increased mortality in shock patients. Therefore, this study aims to investigate whether a resuscitation algorithm based on optimizing left VAC during the initial resuscitation can improve prognosis in patients with septic shock. METHODS: This pilot study was conducted in an intensive care unit (ICU) of a tertiary teaching hospital in China. A total of 83 septic shock patients with left ventricular-arterial uncoupling (i.e., the Ea/Ees ratio ≥ 1.36) were randomly assigned to receive usual care (usual care group, n = 42) or an algorithm-based resuscitation that attempt to reduce the Ea/Ees ratio to 1 within the first 6 h after randomization (VAC-optimized group, n = 41). The left VAC was evaluated by transthoracic echocardiography every 2 h during the study period. The primary endpoint was 28-days mortality. The secondary endpoints included lactate clearance rate, length of ICU stay, and duration of invasive mechanical ventilation (IMV). RESULTS: Eighty-two patients (98.8%) completed the study and were included in the final analysis. The Ea/Ees ratio was reduced in both groups, and the decrease in Ea/Ees ratio in the VAC...