A Circulating Myocardial Depressant Substance is Associated with Cardiac Dysfunction and Peripheral Hypoperfusion: Patient Population

In: Septic Shock

29 Oct 2014

“Possible” septic shock was defined as fever (38°C or higher) and hypotension (mean arterial pressure 60 mm Hg or less). The diagnosis of septic shock was confirmed in 34 of these 50 patients. “Confirmed” septic shock was defined using one of two sets of criteria: (1) fever, hypotension, and positive blood cultures (21 patients); or (2) fever, hypotension, and a localized culture-positive infection, but negative blood cultures, attributed either to the transient nature of bacteremia or to concomitant broad-spectrum antibiotic therapy (13 patients). The remaining 16 patients proved to be critically ill but did not have sepsis or septic shock. All subjects gave informed consent and the study protocol was approved by the institutional committee on human research.

Hemodynamic Evaluation
Arterial pressure was monitored by an indwelling catheter in the radial or femoral artery. A flow-directed, balloon-tipped thermodilution pulmonary artery catheter was inserted into each patient. Serial measurements (every 6 to 8 h) were made of central venous pressure, pulmonary artery wedge pressure (measured at end-expiration), and cardiac output by the thermodilution technique. The following hemodynamic data were calculated according to standard formulas; cardiac index in L/min/m*; stroke volume index in ml/m2; and systemic vascular resistance in dynes*s/cm. The hemodynamic values reported here were obtained at initial line placement (immediately on entry of each patient into our septic shock study) and at the time of each radionuclide cineangiographic study. other
The 50 patients had serial blood samples drawn according to the following protocol. Two samples were obtained within 24 h of the onset of the clinical septic shock syndrome, and one sample was obtained on each of days 2, 3, 4, and 5. Blood was allowed to clot and retract in glass test tubes without antiocoagulant for approximately 45 min, it was spun at 1,000 rpm for 10 min, and serum was removed and stored at — 70°C. MDS activity resisted rapid thawing to room temperature and freezing at – 70°C for at least 36 months.


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