0
Abstract: Poster Presentations |

AUTONOMIC NERVOUS SYSTEM-BASED EARLY GOAL DIRECTED THERAPY IN THE TREATMENT OF SEVERE SEPSIS AND SEPTIC SHOCK: PRELIMINARY EVIDENCE FREE TO VIEW

William C. Shoemaker, MD; Adam Colombo, DO; Joseph Colombo, PhD*
Author and Funding Information

Department of Science and Technology, Bucks County Community College, Newtown, PA


Chest


Chest. 2005;128(4_MeetingAbstracts):378S. doi:10.1378/chest.128.4.2739
Text Size: A A A
Published online

Abstract

PURPOSE:  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.

METHODS:  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.

RESULTS:  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.

CONCLUSION:  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.

CLINICAL IMPLICATIONS:  Shows a correlation between the condition of severe sepsis and septic shock patients and their autonomic balance.

DISCLOSURE:  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.

12:30 PM - 2:00 PM


Figures

Tables

References

NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).

Some tools below are only available to our subscribers or users with an online account.

Related Content

Customize your page view by dragging & repositioning the boxes below.

  • CHEST Journal
    Print ISSN: 0012-3692
    Online ISSN: 1931-3543