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FalĂȘncia ventricular direita no choque sĂ©ptico
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Introdução: A sĂ©psis Ă© uma patologia complexa que resulta de uma resposta desregulada do hospedeiro Ă infeção e que causa disfunção multiorgĂąnica, choque e morte. A disfunção miocĂĄrdica induzida por sĂ©psis Ă© uma entidade sub-reconhecida com implicaçÔes prognĂłsticas. Apesar da disfunção ventricular esquerda ter jĂĄ sido extensamente estudada, existem poucos dados relativos Ă disfunção do ventrĂculo direito. Objetivo: Este trabalho teve como objetivos estudar a incidĂȘncia da falĂȘncia do ventrĂculo direito em doentes com choque sĂ©ptico, caracterizar esta população relativamente a parĂąmetros clĂnicos e laboratoriais e avaliar associação da falĂȘncia ventricular direita com resultados clĂnicos, nomeadamente, mortalidade no Serviço de Medicina Intensiva, tempo de internamento no Serviço de Medicina Intensiva, incidĂȘncia de lesĂŁo renal aguda e de ARDS, tempo de ventilação mecĂąnica e necessidade de hemodiafiltração venovenosa contĂnua (HDFVVC). Materiais e MĂ©todos: Trata-se de um estudo observacional retrospetivo unicĂȘntrico, realizado atravĂ©s da consulta do processo clĂnico dos doentes com choque sĂ©ptico admitidos ou diagnosticados no Serviço de Medicina Intensiva do Hospital de Santa Maria entre janeiro de 2016 e dezembro de 2018. Estabeleceu-se como critĂ©rio de inclusĂŁo a realização de ecocardiograma transtorĂĄcico nas primeiras 48 horas apĂłs a instalação de choque sĂ©ptico. ExcluĂram-se os doentes com presença documentada de disfunção ventricular direita prĂ©via ao internamento ou ausĂȘncia de janela acĂșstica adequada. Definiu-se falĂȘncia do ventrĂculo direito como dilatação do ventrĂculo direito com retificação do septo e interdependĂȘncia ventricular e/ou compromisso de função ventricular direita avaliada com recurso a modo M e doppler tecidular. Resultados: Dos 137 doentes estudados, 33 (24,1%) apresentavam falĂȘncia ventricular direita. A idade mediana deste grupo era 71,0 anos e 54,4% eram do sexo masculino. Os doentes com falĂȘncia do ventrĂculo direito apresentavam valores significativamente superiores no score SOFA Ă admissĂŁo (12 vs. 9,5 pontos, p<0.001), no score SAPS II (71,0 vs. 57,0 pontos, p<0.001), de dose de noradrenalina Ă admissĂŁo (48,5 vs. 30,0 ÎŒg/min, p=0.047) e de concentração sĂ©rica de lactato Ă admissĂŁo (40,0 vs. 23,0 mg/dL, p=0.005). Quanto aos resultados, verificou-se que a necessidade de HDFVVC era
significativamente maior no grupo dos doentes com falĂȘncia ventricular direita (69,7%
vs. 36,5%, p<0.001).
Background: Sepsis is a complex pathology that results from a dysregulated host response to infection and consecutively causes organ dysfunction, shock, and death. Sepsis-induced myocardial dysfunction is an under-recognised entity with prognostic implications. Although left ventricular dysfunction has been extensively studied, there is scarce data available about the dysfunction of the right ventricle. Aim: The aims of this study were to report the incidence of right ventricular failure in septic shock patients, describe this population regarding their clinical features and laboratory characteristics, and evaluate the association of right ventricular failure with clinical outcomes, such as mortality in the Intensive Care Unit (ICU), length of stay in the ICU, incidence of acute kidney injury and acute respiratory distress syndrome (ARDS), duration of mechanical ventilation and requirement of continuous venovenous hemodiafiltration (CVVHDF). Methods: This was a single-centre retrospective observational study using data obtained from the clinical files of septic shock patients admitted to the intensive care unit at Hospital de Santa Maria between January 2016 and December 2018. The criterion for inclusion was the execution of a transthoracic echocardiogram within 48 hours of septic shock onset. Patients with previously documented right ventricular dysfunction or with a poor echocardiographic acoustic window were excluded. Right ventricular failure was defined as dilation of the right ventricle accompanied by rectification of the septum and ventricular interdependence and/or impairment of right ventricular function assessed by M mode and tissue doppler. Results: Of the 137 patients included in the study, 33 (24,1%) showed right ventricular failure. The median age of this group was 71,0 years old and 54,4% were male. Patients with right ventricular failure had significantly higher SOFA score calculated on admission (12 vs. 9,5 points, p<0.001), SAPS II score (71,0 vs. 57,0 points, p<0.001), norepinephrine dosage on admission (48,5 vs. 30,0 ÎŒg/min, p=0.047) and serum lactate levels on admission (40,0 vs. 23,0 mg/dL, p=0.005). Regarding clinical outcomes, the need for CVVHDF was significantly higher in the group of patients with right ventricular failure (69,7% vs. 36,5%, p<0.001).Conclusion: Right ventricular failure in septic shock is associated with greater severity of illness, higher indices of circulatory failure and a greater need for renal replacement therapy.
Background: Sepsis is a complex pathology that results from a dysregulated host response to infection and consecutively causes organ dysfunction, shock, and death. Sepsis-induced myocardial dysfunction is an under-recognised entity with prognostic implications. Although left ventricular dysfunction has been extensively studied, there is scarce data available about the dysfunction of the right ventricle. Aim: The aims of this study were to report the incidence of right ventricular failure in septic shock patients, describe this population regarding their clinical features and laboratory characteristics, and evaluate the association of right ventricular failure with clinical outcomes, such as mortality in the Intensive Care Unit (ICU), length of stay in the ICU, incidence of acute kidney injury and acute respiratory distress syndrome (ARDS), duration of mechanical ventilation and requirement of continuous venovenous hemodiafiltration (CVVHDF). Methods: This was a single-centre retrospective observational study using data obtained from the clinical files of septic shock patients admitted to the intensive care unit at Hospital de Santa Maria between January 2016 and December 2018. The criterion for inclusion was the execution of a transthoracic echocardiogram within 48 hours of septic shock onset. Patients with previously documented right ventricular dysfunction or with a poor echocardiographic acoustic window were excluded. Right ventricular failure was defined as dilation of the right ventricle accompanied by rectification of the septum and ventricular interdependence and/or impairment of right ventricular function assessed by M mode and tissue doppler. Results: Of the 137 patients included in the study, 33 (24,1%) showed right ventricular failure. The median age of this group was 71,0 years old and 54,4% were male. Patients with right ventricular failure had significantly higher SOFA score calculated on admission (12 vs. 9,5 points, p<0.001), SAPS II score (71,0 vs. 57,0 points, p<0.001), norepinephrine dosage on admission (48,5 vs. 30,0 ÎŒg/min, p=0.047) and serum lactate levels on admission (40,0 vs. 23,0 mg/dL, p=0.005). Regarding clinical outcomes, the need for CVVHDF was significantly higher in the group of patients with right ventricular failure (69,7% vs. 36,5%, p<0.001).Conclusion: Right ventricular failure in septic shock is associated with greater severity of illness, higher indices of circulatory failure and a greater need for renal replacement therapy.
Descrição
Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2021
Palavras-chave
SĂ©psis Choque sĂ©ptico Disfunção miocĂĄrdica induzida por sĂ©psis FalĂȘncia ventricular direita Ecocardiograma