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BioMed Research International
Volume 2013 (2013), Article ID 930673, 7 pages
http://dx.doi.org/10.1155/2013/930673
Clinical Study

Cardiac Contractile Reserve Parameters Are Related to Prognosis in Septic Shock

1Service de Réanimation Médicale Brabois, CHU de Nancy, 54511 Vandoeuvre les Nancy, France
2INSERM, Centre d’Investigations Cliniques-9501 and CHU de Nancy, 54511 Vandoeuvre les Nancy, France
3Université de Lorraine, Nancy, France

Received 7 April 2013; Revised 10 June 2013; Accepted 24 June 2013

Academic Editor: Boris Jung

Copyright © 2013 Antoine Kimmoun et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Introduction. Cardiac reserve could be defined as the spontaneous magnitude from basal to maximal cardiac power under stress conditions. The aim of this study was to evaluate the prognostic value of cardiac reserve parameters in resuscitated septic shock patients. Methods. Seventy patients with septic shock were included in a prospective and observational study. Prior to inclusion, patients were resuscitated to reach a mean arterial pressure of 65–75 mmHg with an euvolemic status. General, hemodynamic, and cardiac reserve-related parameters (cardiac index, double product, and cardiac power index) were collected at inclusion and at day 1. Results. Seventy patients were included with 28-day mortality at 38.5%. Ten of the 70 patients died during the first day. In multivariate analysis, independent predictors of death were SAPS II ≥58 (OR: 3.36 [1.11–10.17]; ), a high double product at inclusion (OR [95% IC]: 1.20 [1.00–1.45] per 103 mmHg·min; ), and at day 1, a decrease in cardiac index (1.30 [1.08–1.56] per 0.5 L/min/m2; ) or cardiac power index (1.84 [1.18–2.87] per 0.1 W/m2, ). Conclusion. In the first 24 hours, parameters related to cardiac reserve, such as double product and cardiac index evolution, provide crucial and easy to achieve hemodynamic physiological information, which may impact the outcome.