2008, Number 2
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Med Crit 2008; 22 (2)
Cardiac power for to evaluate response to threat of dobutamine in patients with septic shock
Arcos ZM, Monares ZE, Sánchez CC, Colín EV, Etulain GJE, Poblano MM, Aguirre SJ, Martínez SJ
Language: Spanish
References: 15
Page: 74-79
PDF size: 95.96 Kb.
ABSTRACT
Introduction: The cardiac power (CP) is an estimation of the function of the heart pump. CP is the strongest hemodynamic correlate of mortality in cardiogenic shock.
Methods: Objective: To evaluate the use of the CP in the prognosis of patients with septic shock (SS). Retrospective study, included patients (p) with diagnosis of SS with catheter of Swan-Ganz from january 2006 to may 2007. The CP, the delta of CP after dobutamine administration, hemodynamic variables, and oxygen transport were measured at the start of the study and 24 h later. The following formulas were used:
CP = Mean arterial pressure - Central venous pressure x cardiac output / 451
% CP change = (CP after dobutamine * 100 / CP before dobutamine) - 100
Results:
Survivors Non survivors
Variable (n = 27) (n = 15) P
Age (years) 69 (49-77) 71 (61-77) NS
Length of 8 (6-9) 4 (2- 10) 0.02
stay (days)
APACHE II 27 (22-28) 29 (27-30) NS
(points)
Previous PC (W) 0.7 (0.5-1.0) 0.8 (0.6-1.0) NS
Post PC (W) 1.2 (1.0-1.5) 0.6 (0.5-0.8) ‹0.001
PC Change (%) 62 (27-100) -20 (-40-25) ‹ 0.001
The cut point to mortality prediction was £ 25% in % CP´s change, with an 80% sensibility and 85.2% specificity, obtaining an area under the ROC curve of 0.840. PPV 75%, NPV 88.5%.
Conclusion: The change of CP after the dobutamine challenge is a good predictor of mortality in SS.
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