Non-invasive Hemodynamic Monitoring in Prediction of the Outcome and Prognosis in Sepsis

Abstract Background Complex disease syndromes such as sepsis require multimodal diagnostic and therapeutic approaches. Besides the diagnosis of septic shock and early causal therapy, one major challenge in its treatment remains the resuscitation and management of cardiocirculatory and respiratory dysfunction. As Pulmonary artery catheterization poses significant risks and requires specialized training. Technological advances allow for more readily available, noninvasive clinical measurements of hemodynamics. Impedance cardiography (ICG) offers the potential for safe, noninvasive hemodynamic monitoring that can be easily applied. Objective To evaluate the effect of cardiac index, mean arterial blood pressure, heart rate, and oxygen delivery as measured noninvasively by impedance cardiography (ICG) in prediction of the outcome and prognosis in sepsis. Patients and Methods This is a prospective, observational convenience trial of patients presenting to the ED or the ICU with severe sepsis or septic shock. The patients were part of a cohort that was followed at day 1, day 3 and day7, or until hospital discharge or in-hospital death. After Approval is obtained from the research ethics committee of anesthesia and intensive care department, Ain Shams University. Oral informed consent is obtained from the patient or designated surrogate before data collection begins. Results Twenty-three were enrolled; three were excluded due to an inability to complete data acquisition. The mean cardiac index in nonsurvivors (2.3 L / minÆm2, 95% CI = 2.1 to 2.6) was less than that for survivors (3.3, 95% CI = 2.9 to 3.5). Oxygen delivery as well as lactate were less in non-survivors group. A cardiac index of < 2.5 L / minÆm2 had a sensitivity of 43% (95% CI = 18% to 71%), specificity of 93% (95% CI = 80% to 95%), for predicting in-hospital mortality. Conclusions Early, noninvasive measurement of the cardiac index in critically ill severe sepsis and septic shock patients can be performed in the ED for those who meet criteria for EGDT. There appears to be an association between an initial lower cardiac index as measured noninvasively and in-hospital mortality.