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Noradrenaline modifies arterial reflection phenomena and left ventricular efficiency in septic shock patients: A prospective observational study
Hosp SAS Jerez, Serv Cuidados Intens, C Circunvalac S-N, Jerez de la Frontera 11407, Spain.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Hedenstierna laboratory. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care. CIBER Enfermedades Resp CIBERES, Avd Monforte de Lemos 3-5,Pabellon 11,Planta 0, Madrid 28029, Spain.
Hosp SAS Jerez, Serv Cuidados Intens, C Circunvalac S-N, Jerez de la Frontera 11407, Spain.
Hosp SAS Jerez, Serv Cuidados Intens, C Circunvalac S-N, Jerez de la Frontera 11407, Spain.
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2018 (English)In: Journal of critical care, ISSN 0883-9441, E-ISSN 1557-8615, Vol. 47, p. 280-286Article in journal (Refereed) Published
Abstract [en]

Purpose: To determine whether noradrenaline alters the arterial pressure reflection phenomena in septic shock patients and the effects on left ventricular (LV) efficiency.

Material and methods: Thirty-seven septic shock patients with a planned change in noradrenaline dose. Timing and magnitude (Reflection Magnitude and Augmentation Index) of arterial reflections were evaluated. Total, steady, and oscillatory LV power (also expressed as fraction of the total power), subendocardial viability ratio (SEVR), energy efficiency and transmission ratios were used as a marker of LV efficiency.

Results: An incremental change in noradrenaline increased Reflection Magnitude [0.28(0.09) to 0.31(0.1], Augmentation Index [-6.4(23.6) to 4.8(20.7)%], and LV total power [0.79(IQR:0.47-1) to 0.98(IQR:0.57-127) W], all p < 0.001; whereas decreased arrival time of reflected waves [from 95(87 to 121) to 83(79 to 101)ms; p < 0.001]. Variables of LV performance showed a decreased efficiency: oscillatory fraction and energy efficiency ratio increased [20.9(5.7) to 22.8(4.9)%, and 82(1.7) to 10.1(2) mW.min.litre(-1); p < 0.001, respectively]; and energy transmission ratio and SEVR decreased [73.8(9.9) to 72(9.8)% and 146(IQR:113-188) to 143 (IQR:109-172)%, p = 0.003 and p = 0.041, respectively].

Conclusions: Noradrenaline increased reflection phenomena, increasing LV workload and worsening LV performance in septic shock patients. These conditions could explain the detrimental effects during long-term use of noradrenaline.

Place, publisher, year, edition, pages
W B SAUNDERS CO-ELSEVIER INC , 2018. Vol. 47, p. 280-286
Keywords [en]
Septic shock, Noradrenaline, Arterial pressure, Pulse wave analysis, Pulse wave velocity
National Category
Anesthesiology and Intensive Care
Identifiers
URN: urn:nbn:se:uu:diva-363203DOI: 10.1016/j.jcrc.2018.07.027ISI: 000444896900046PubMedID: 30096635OAI: oai:DiVA.org:uu-363203DiVA, id: diva2:1256970
Available from: 2018-10-18 Created: 2018-10-18 Last updated: 2018-10-18Bibliographically approved

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