In: Septic Shock30 Oct 2014
Initial and serial ECG-gated radionuclide cineangiographic studies were performed on all patients at the bedside using techniques that have been described in detail previously. Patients received an injection of stannous pyrophosphate, and 30 min later they each received 0.3 mCi/kg ®®mTc to accomplish in vivo labeling of erythrocytes. These radionuclide scans were obtained using a portable Picker camera according to the following previously described protocol. The initial scan was performed within the first 24 to 48 h of patient entry into the septic shock protocol. A follow-up scan was obtained at two to four days after entry into the study.
A recovery scan was defined as a scan performed at least five days (usually five to eight days) after clinical recovery from the acute illness, or a scan demonstrating recovery to a patients presepsis EF. Radionuclide LVEF was calculated as (EDC – ESC)/(EDC – Bkgd), where EDC = end-diastolic counts, ESC = end-systolic counts, and Bkgd = background counts. The end-diastolic volume index (EDVI) was calculated from simultaneously obtained hemodynamic studies and EF, using the formula EDVI = stroke volume index (from thermodilution cardiac output) divided by EF (from radionuclide cineangiography). there
Each patient was treated according to a uniform therapeutic protocol by the same group of critical care physicians. The major therapeutic goal was to maintain a mean arterial pressure of at least 60 mm Hg. Initially, all patients received IV fluids to maintain a mean pulmonary artery wedge pressure of 15 mm Hg. Dopamine was then added if the patient remained hypotensive. If the patient required >20 ^.g/kg/min of dopmaine, norepinephrine was added, and the dopamine was tapered to 2 ^.g/kg/min in an attempt to preserve renal perfusion. All patients received broad-spectrum antibiotic coverage. Respiratory support was given as needed to maintain a normal pH and an arterial oxygen saturation >90 percent. Metabolic parameters were checked frequently, and abnormalities, especially of potassium, phosphate, calcium, and magnesium, were corrected promptly.
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