J. J. Butz1, Y. Shan1, R. Shadis1, J. Yuschak1, O. Kirton1, T. Vu1 1Abington Memorial Hospital,Trauma / Critical Care Surgery,Abington, PA, USA
Introduction: Sepsis as a disease process still requires further research into the diagnostic parameters best suited for practical clinical application. While electronic heart rate, blood pressure, and pulse oximetry methods are employed routinely in hospitals, room exists for additional measurements to be used in the identification, resuscitative, and monitoring phases of sepsis management.
Methods: Using a limited sample population (n= 9), cardiac impedance monitors were placed on patients identified to fit SIRS criteria from the 2012 iteration of the Surviving Sepsis Campaign Guidelines. Measurements of stroke volume, heart rate, cardiac output, cardiac index, blood pressure, contractility index, thoracic fluid content, ejection time, ejection fraction, cardiac work index, and systemic vascular resistance were obtained and compared prior to and after administration of a resuscitative two-liter crystalloid infusion.
Results: Measurements at presentation and one hour after fluid resuscitation were: heart rate (bpm) [97±15 & 93±19: p=0.23], mean arterial pressure (mmHg) [81±14 & 85±14: p=0.55], systemic vascular resistance (dyne-s/cm-5) [861±242 & 1087±424: p=0.04], afterload measured as systemic vascular resistance index (dyne-s/cm-5/m2) [1813±369 & 2283±696: p=0.04], and left cardiac work index (kg*m/m2) [3.6±1.5 & 3.3±1.3: p=0.69].
Conclusion: In the limited sample size presented, systemic vascular resistance proved to be statistically more sensitive in its capacity to recognize and monitor resuscitative management of sepsis and septic shock than either of the conventional hemodynamic parameters of heart rate and blood pressure. As a practical application, it could serve to enter hospitals nationwide as a new vital sign of sepsis.
