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Critical Care |

An Early Phenotype Allows Distinction of Survivors From Nonsurvivors in Sepsis

François Dépret, MD; Fabien Picard, MD; Sergio Zanotti-Cavazzoni, MD; Steven Hollenberg, MD
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Cooper University Hospital, Camden, NJ


Chest. 2014;145(3_MeetingAbstracts):187A. doi:10.1378/chest.1836669
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Abstract

SESSION TITLE: Critical Care Posters III

SESSION TYPE: Poster Presentations

PRESENTED ON: Saturday, March 22, 2014 at 01:15 PM - 02:15 PM

PURPOSE: We previously demonstrated in a clinically relevant murine model of sepsis, that animals with left ventricular (LV) dilation had better cardiovascular performance and increased survival. Using the same model of sepsis, we sought to determine if survivors have an early phenotype different from non-survivors with different resuscitation regiment.

METHODS: 90 C57Bl/6 mice were used, 76 wild type (WT) and 14 inducible nitric oxide synthase knockouts (KO). 81 septic mice had cecal ligation and puncture followed by fluid and antibiotic resuscitation (4 different groups of resuscitation: initial only: n=19, full: n=25 WT and n=14 KO, partial: n=18 and no fluid: n=5) and 9 control mice received sham ligation. Echocardiography was performed at baseline and every 3 hours after CLP during 72 hours. SV, CO, LV internal diameter in diastole (LVIDd), and fractional shortening (FS) were measured. Mice were classified as survivors (alive after 72hours) and non-survivors. We compared SV, CO, LVIDd, FS, heart rate and temperature between these two groups.

RESULTS: Among septic animals, 55% survived (45/81). Median survival was 36 hours. At 3 hours, temperature (35±1.1°C vs 34±1.2°C, p=0.003), LVIDd (3.1±0.4mm vs 2.8±0.4mm, p=0.0005), variation of LVIDd (78±8% vs 71±9%, p=0.0007), SV (25±7.4μL vs 20±5.2μL, p=0.0004) and CO (13±3.9mL/min vs 10±2.7mL/min, p=0.0008) were higher in survivors. At 9 hours HR (466±52BPM vs 434±61BPM, p=0.01) was also higher in survivors. Interestingly, there was no difference for FS between survivors and non-survivors.

CONCLUSIONS: We found that survivors develop within the first 3 hours a phenotype defined by higher LV diastolic diameter, higher SV, higher CO, and higher temperature without any significant change in FS, independent of the resuscitation regiment.

CLINICAL IMPLICATIONS: These results suggest that hemodynamic parameters can distinguish survivors from non-survivors early in the course of murine sepsis. The fact that diastolic and not systolic parameters of LV function distinguish is interesting and potentially useful.

DISCLOSURE: The following authors have nothing to disclose: François Dépret, Fabien Picard, Sergio Zanotti-Cavazzoni, Steven Hollenberg

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