To investigate the clinical efficacy of early goal-directed therapy based on autonomic nervous system (ANS) monitoring (non-invasive, simultaneous, independent measures of sympathetic (SNS) and parasympathetic nervous system (PSNS) activity) in patients with severe sepsis and septic shock.
208 severe sepsis and septic shock patients were studied in an urban, level 1 university-run trauma service.: ANS monitoring measured the sequential patterns of SNS and PSNS activity immediately after admission to the emergency department (ED). Also measured noninvasive hemodynamic patterns, including: cardiac index (CI) by bioimpedance, as well as HR, and mean arterial pressure (MAP) to evaluate cardiac function, pulse oximetry to reflect changes in respiratory function, and transcutaneous oxygen (PtcO2) to reflect tissue perfusion/oxygenation.
In all patients autonomic balance (the ratio of SNS to PSNS activity) was markedly abnormal. These patients also had low MAP, CI, and PtcO2/FiO2 values associated with increased HRV that reflect increased autonomic activity. Patients with improved or restored ANS early in their ED stay, all survived; while the latter admission to ED had mixed results. ANS balance was not well-correlated with HR, BP, and CI.
In nonsurvivors, severe sepsis and septic shock were associated with pronounced ANS imbalance. Survivors had relatively normal ANS balance. Patients that first presented poor ANS balance had balance improved due to therapy, also survived.
Shows a correlation between the condition of severe sepsis and septic shock patients and their autonomic balance.
Joseph Colombo, Shareholder Joe Colombo, PhD is a share holder and part owner of Ansar, Inc.; Employee Joe Colombo is the Executive VP and Medical Director of Ansar, Inc.