Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 Jan 4;10(1):1.
doi: 10.1186/s40560-021-00587-z.

Esmolol response in septic shock patients in relation to vascular waterfall phenomenon measured by critical closure pressure and mean systemic filling pressure: a prospective observational study

Zehan Liu  1   2 , Chuanliang Pan  3 , Jianping Liu  1 , Hui Liu  1 , Hui Xie  1
Affiliations

Esmolol response in septic shock patients in relation to vascular waterfall phenomenon measured by critical closure pressure and mean systemic filling pressure: a prospective observational study

Zehan Liu et al. J Intensive Care. .

Abstract

Background: Bedside measurements of critical closure pressure (Pcc) and mean systemic circulation filling pressure (Pmsf) were utilized to evaluate the response to esmolol in septic shock patients, in relation to the vascular waterfall phenomenon and body oxygen supply and demand.

Methods: This prospective observational self-controlled study included patients with septic shock, newly admitted to the intensive care unit, between August 2019 and January 2021. Pcc and Pmsf, along with the heart rate and other hemodynamic indicators were observed and compared before and 1 h after esmolol IV infusion.

Results: After 24 h of initial hemodynamic optimization, 56 patients were finally enrolled. After start of esmolol infusion, patients had a significant decrease in cardiac index (CI) (4.0 vs. 3.3 L/min/m2, P < 0.001), a significant increase in stroke index (SI) (34.1 vs. 36.6 mL/m2, P < 0.01), and a significant decrease in heart rate (HR) (116.8 vs. 90.6 beats/min, P < 0.001). After 1 h of treatment with esmolol, patients had a significant increase in Pcc (31.4 vs. 36.7 mmHg, P < 0.01). The difference between Pcc and Pmsf before and after treatment was statistically different (4.0 vs. 10.0 mmHg, P < 0.01). After heart rate control with esmolol, the patients had a significant increase in the body circulation vascular resistance indices (RIs) (15.14 vs. 18.25 mmHg/min/m2/L, P < 0.001). There was an increase in ScvO2 in patients after treatment with esmolol, but the difference was not statistically significant (68.4% vs. 69.8%, P > 0.05), while Pcv-aCO2 was significantly lower (6.3 vs. 4.9 mmHg, P < 0.001) and patients had a significant decrease in blood lactate levels (4.0 vs. 3.6 mmol/L, P < 0.05).

Conclusion: Patients with septic shock whose heart rate is greater than 95 beats/min after hemodynamic optimization were treated with esmolol, which could effectively control heart rate and reduce CI, as well as improve Pcc and increase the difference between Pcc and Pmsf (known as "vascular waterfall" phenomenon), without affecting MAP, CVP, Pmsf and arteriovenous vascular resistance, and improve the balance of oxygen supply and demand in the body.

Keywords: Critical closure pressure; Esmolol; Mean systemic circulation filling pressure; Septic shock; Vascular waterfall.

PubMed Disclaimer

Conflict of interest statement

None of the authors declare any conflicts of interest.

Figures

Fig. 1
Fig. 1
Patient flowchart
Fig. 2
Fig. 2
a Comparation of difference of PCC and Pmsf before and after esmolol treatment (*P = 0.009); b Comparation of PCC and Pmsf before and after esmolol treatment (Pcc: #P = 0.008). The bold lines and bars represent means, the error bars represent 95% confidence intervals
Fig. 3
Fig. 3
Changes of vascular resistance index
Fig. 4
Fig. 4
Correlation analysis of Pcc-Pmsf and lactate levels. a Before esmolol treatment (P = 0.404); b After esmolol treatment (P = 0.161); c The relationship between the changes of vascular waterfall and the changes of lactic acid before and after treatment (P = 0.460). The blue line is linear regression
See this image and copyright information in PMC

References

    1. Singer M, Deutschman CS, Seymour CW, Shankar-Hari M, Annane D, Bauer M, Bellomo R, Bernard GR, Chiche JD, Coopersmith CM, Hotchkiss RS. The third international consensus definitions for sepsis and septic shock (sepsis-3) JAMA. 2016;315(8):801–810. doi: 10.1001/jama.2016.0287. - DOI - PMC - PubMed
    1. Joannidis M. Continuous renal replacement therapy in sepsis and multisystem organ failure. Semin Dial. 2009;22(2):160–164. doi: 10.1111/j.1525-139X.2008.00552.x. - DOI - PubMed
    1. Liaudet L, Calderari B, Pacher P. Pathophysiological mechanisms of catecholamine and cocaine-mediated cardiotoxicity. Heart Fail Rev. 2014;19(6):815–824. doi: 10.1007/s10741-014-9418-y. - DOI - PubMed
    1. Permutt S, Riley RL. Hemodynamics of collapsible vessels with tone: the vascular waterfall. J Appl Physiol. 1963;18:924–932. doi: 10.1152/jappl.1963.18.5.924. - DOI - PubMed
    1. Farhi ER, Klocke FJ, Mates RE, et al. Tone-dependent waterfall behavior during venous pressure elevation in isolated canine hearts. Circ Res. 1991;68(2):392–401. doi: 10.1161/01.RES.68.2.392. - DOI - PubMed

LinkOut - more resources