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Observational Study
. 2015 Aug 31;19(1):304.
doi: 10.1186/s13054-015-1014-6.

Association of left ventricular longitudinal strain with central venous oxygen saturation and serum lactate in patients with early severe sepsis and septic shock

Michael J Lanspa  1   2 , Joel E Pittman  3 , Eliotte L Hirshberg  4   5   6 , Emily L Wilson  7 , Troy Olsen  8 , Samuel M Brown  9   10 , Colin K Grissom  11   12
Affiliations
Observational Study

Association of left ventricular longitudinal strain with central venous oxygen saturation and serum lactate in patients with early severe sepsis and septic shock

Michael J Lanspa et al. Crit Care. .

Abstract

Introduction: In septic shock, assessment of cardiac function often relies on invasive central venous oxygen saturation (ScvO2). Ventricular strain is a non-invasive method of assessing ventricular wall deformation and may be a sensitive marker of heart function. We hypothesized that it may have a relationship with ScvO2 and lactate.

Methods: We prospectively performed transthoracic echocardiography in patients with severe sepsis or septic shock and measured (1) left ventricular longitudinal strain from a four-chamber view and (2) ScvO2. We excluded patients for whom image quality was inadequate or for whom ScvO2 values were unobtainable. We determined the association between strain and ScvO2 with logistic and linear regression, using covariates of mean arterial pressure, central venous pressure, and vasopressor dose. We determined the association between strain and lactate. We considered strain greater than -17% as abnormal and strain greater than -10% as severely abnormal.

Results: We studied 89 patients, 68 of whom had interpretable images. Of these patients, 42 had measurable ScvO2. Sixty percent of patients had abnormal strain, and 16% had severely abnormal strain. Strain is associated with low ScvO2 (linear coefficient -1.05, p =0.006; odds ratio 1.23 for ScvO2 <60%, p =0.016). Patients with severely abnormal strain had significantly lower ScvO2 (56.1% vs. 67.5%, p <0.01) and higher lactate (2.7 vs. 1.9 mmol/dl, p =0.04) than those who did not. Strain was significantly different between patients, based on a threshold ScvO2 of 60% (-13.7% vs. -17.2%, p =0.01) but not at 70% (-15.0% vs. -18.2%, p =0.08).

Conclusions: Left ventricular strain is associated with low ScvO2 and hyperlactatemia. It may be a non-invasive surrogate for adequacy of oxygen delivery during early severe sepsis or septic shock.

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Figures

Fig. 1
Fig. 1
Scatterplots of (a) left ventricular ejection fraction (EF) and central venous oxygen saturation (ScvO2), (b) longitudinal strain and ScvO2, (c) EF and lactate, and (d) strain and lactate. These graphs illustrate that elevated lactate and low ScvO2 may be observed with elevated EF but are less often observed with normal strain
See this image and copyright information in PMC

References

    1. Joshi R, de Witt B, Mosier JM. Optimizing oxygen delivery in the critically ill: the utility of lactate and central venous oxygen saturation (ScvO2) as a roadmap of resuscitation in shock. J Emerg Med. 2014;47:493–500. doi: 10.1016/j.jemermed.2014.06.016. - DOI - PubMed
    1. Vieillard-Baron A, Caille V, Charron C, Belliard G, Page B, Jardin F. Actual incidence of global left ventricular hypokinesia in adult septic shock. Crit Care Med. 2008;36:1701–6. doi: 10.1097/CCM.0b013e318174db05. - DOI - PubMed
    1. Rivers E, Nguyen B, Havstad S, Ressler J, Muzzin A, Knoblich B, et al. Early goal-directed therapy in the treatment of severe sepsis and septic shock. N Engl J Med. 2001;345:1368–77. doi: 10.1056/NEJMoa010307. - DOI - PubMed
    1. Dellinger RP, Levy MM, Rhodes A, Annane D, Gerlach H, Opal SM, et al. Surviving Sepsis Campaign: international guidelines for management of severe sepsis and septic shock: 2012. Crit Care Med. 2013;41:580–637. doi: 10.1097/CCM.0b013e31827e83af. - DOI - PubMed
    1. Ruesch S, Walder B, Tramèr MR. Complications of central venous catheters: internal jugular versus subclavian access—a systematic review. Crit Care Med. 2002;30:454–60. doi: 10.1097/00003246-200202000-00031. - DOI - PubMed

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