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Critical Care |

Pulmonary Arterial Hypertension in Severe Sepsis and Septic Shock

Sonia Castillo, MD; Ashraf Alhafez, MD; Lewis Satterwhite, MD; Steven Simpson, MD
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University of Kansas Medical Center, Kansas City, KS


Chest. 2013;144(4_MeetingAbstracts):421A. doi:10.1378/chest.1702910
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Abstract

SESSION TITLE: Sepsis and Shock Posters

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 30, 2013 at 01:30 PM - 02:30 PM

PURPOSE: To compare clinical parameters in the management of severe sepsis and septic shock between patients with and without pulmonary arterial hypertension (PAH).

METHODS: We retrospectively studied 47 patients with PAH and 94 without PAH admitted to our Medical Intensive Care Unit (MICU) for severe sepsis or septic shock from 2007 to 2012. Medical records were reviewed for clinical, demographic and hemodynamic variables. Statistical analysis was done using SPSS version 20.

RESULTS: There was no difference in age between the 2 groups (59.9±14.0 vs 55.3±17.9, p=0.096). The proportion of females was higher in the PAH group (72.3% vs 45.7%, p=0.003). Pneumonia was the most frequent source of sepsis in both groups (31.9% in PAH vs 45.7% in non-PH, p=0.116). Bacteremia was present in 23.4% of PAH patients vs 14.9% of non-PAH patients (p=0.21). The admission lactate level was lower in the PAH group (2.76mmol/L vs 4.5mmol/L, p=0.001). B-type natriuretic peptide (BNP) levels at admission were higher in the PAH group (1410 pg/ml vs 794pg/ml, p=0.002). The amount of intravenous fluids (IVF) received during fluid resuscitation was lower in the PAH group (1.5 liters ±2.4 vs 3.7 liters±1.4, p<0.001). The time to resolution of lactic acidosis was also shorter in the PAH group (0.4 days vs 1.23 days, p<0.001). Nonetheless, the central venous oxygen saturation (ScvO2) was lower in the PAH group (68.0% vs 75.4%, p=0.011). 30-day mortality and lengths of ICU and hospital stay were not different between the two groups.

CONCLUSIONS: PAH patients exhibit distinct clinical features when presenting with severe sepsis or septic shock. PAH patients have lower levels of lactate and ScvO2 upon presentation. These patients receive less IVF overall in our MICU.

CLINICAL IMPLICATIONS: Sepsis is a common problem among patients with PAH. Tissue oxygen extraction appears to be higher in septic PAH patients than in their non-PAH counterparts; the shorter time to resolution of lactic acidosis with smaller amounts of IVF suggests that septic PAH patients require interventions tailored to their specific hemodynamic profiles. Further research is needed to expand and evaluate the significance of these observations.

DISCLOSURE: The following authors have nothing to disclose: Sonia Castillo, Ashraf Alhafez, Lewis Satterwhite, Steven Simpson

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