INVASIVE MONITORING COMBINED WITH 2-DIMENSIONAL ECHOCARDIOGRAPHIC STUDY IN SEPTIC SHOCK

Objective: An investigation into the incidence and the clinical implic ation of discrepancies which may sometimes occur between invasive and non-invasive hemodynamic evaluation in septic patients. Design: A pros pective, consecutive comparison. Setting: Department of Intensive Care Medicine at a University Hospital. Patients: 32 patients undergoing t herapy for an episode of septic shock. Interventions: Conventional hem odynamic support (including volume expansion in all cases and inotropi c support if necessary) required to obtain a stable hemodynamic status . Measurement and results: Cardiac output (thermodilution method), car diac pressures (right heart catheterization) and left ventricular (LV) volumes (two-dimensional echocardiography) were simultaneously record ed. A comparison was thus made between both procedures, particularly c oncerning preload evaluation and assessment of left ventricular systol ic function. Pulmonary artery occlusion pressure measurement was evide nced as an unreliable index of LV end-diastolic volume, determining pr eload. Assessment of LV systolic function by both methods was conflict ing in 11 cases out of the 32. Conclusions: Frequent discrepancies bet ween to invasive and non-invasive procedure were observed. The reasons for these discrepancies, including low vascular resistance, reduced L V compliance, and a possible overestimation of cardiac output by the t hermodilution method, are examined in the light of data recorded. It w as concluded that invasive hemodynamic evaluation by right heart cathe terization in septic patients should be seriously questioned.