Variables hemodinámicas ecocardiográficas asociadas a mortalidad en pacientes con shock séptico en ventilación mecánica

Echocardiographic Hemodynamic Variables Associated with Mortality in Patients with Septic Shock on Mechanical Ventilation

Resumen

Objetive: In this study we aimed to evaluate echocardiographic hemodynamic variables predictive of mortality in patients with septic shock on mechanical ventilation. Methods: We conducted a prospective cohort study in the Emergency and Critical Areas Service of the Hospital Regional Lambayeque, 104 patients with septic shock connected to mechanical ventilation. Results: The exposed cohort included patients with systolic and diastolic dysfunction, while the unexposed cohort included those without ventricular dysfunction. Cox regression analysis determined that predictors of mortality were Left Ventricular Ejection Fraction <50% Hazard Ratio 3.57 (95%
confidence interval 1.25-10) and cardiac index <2.5 Hazard Ratio 7.69 (95% confidence interval 2.5 - 25). In diastolic dysfunction, the only predictor variable for mortality was the mitral flow E wave to mitral annulus tissue Doppler e' wave ratio (E/e') > 15 Hazard ratio 0.11 (95% confidence interval 0.02-0.48). In Kaplan Meier analysis, patients with Tricuspid Annular Plane Systolic Excursion < 17 had a median survival of 3.8 days with Hazard ratio 0.14 (95% confidence interval 0.07-0.28). Conclusion: Echocardiographic monitoring of hemodynamic variables predictive of mortality of left ventricular systolic and diastolic dysfunction as well as right ventricular  dysfunction could be a valuable strategy to improve the management of patients with septic shock on mechanical ventilation.