PiCCO ASSESSMENT IN PATIENTS WITH SEPTIC SHOCK
Condition: Septic Shock
MeSH terms: Shock, Septic; Shock
Study type: Observational

Summary: 
      Sepsis is the result of a complex pathological process which involves an intravascular
      inflammatory state, loss of vascular tone, endothelial injury, extravascular leakage, and
      often inefficient myocardial contractility. These affect the cardiovascular homeostasis as
      well as the regional perfusion and tissue oxygenation of patient. The importance of early
      cardiovascular support in septic patients is the reason why, for about fifteen years, the
      implementation of standardized resuscitation protocols has been emphasized.

      The Surviving Sepsis Campaign Guidelines (SSG) recommend an initial fluid resuscitation
      followed by use of a vasoactive agent such as norepinephrine for the treatment of patients
      with septic shock. To understand the impact of the hemodynamic support provided by the
      resuscitation strategy, the assessment of surrogate clinical parameters is pivotal. According
      to the current guidelines, the increase of mean arterial pressure (MAP) above 65 mmHg
      represents the threshold in defining patients as "stable".

      Although this strategy has been well established, its impact on the actual hemodynamic
      profile of the septic patient, remains a subject of ongoing controversy. In this scenario,
      the transpulmonary thermodilution technique (TPTD) allows invasive assessment of the patient
      hemodynamic profile in terms of fluid responsiveness, vasomotor status, or global cardiac
      efficiency. By using this technique, several studies highlighted a wide variability in the
      individual response of patients undergoing cardiovascular stabilization guided by SSG. This
      suggests that the implementation of a "customized" resuscitation protocol based TPTD derived
      parameters rather than resuscitation strategy guided by a fixed mathematic model, could be
      preferred. However, in daily clinical practice, the use of this advanced hemodynamic
      monitoring system in not routinely used, though it is often reserved in case of failure of
      the initial SSG-resuscitation protocol.

      The investigators supposed that, even if the initial resuscitative efforts were successful in
      achieving the SSG targets i.e. by restoring the MAP > 65 mmHg, this could still be inadequate
      in some patients. Accordingly, the investigators hereby will report the hemodynamic profile
      of patients with septic shock admitted in ICU.
    


Intervention name(s): use of Trasnpulmonary termodiluetion technique
Intervention type(s): Diagnostic Test
Intervention description(s): All the patients underwent to invasive hemodynamic monitoring through the transpulmonary thermodilution technique (PiCCO, PULSION medical system. Gettinge; Solna, Sweden). Briefly, the technique consists in the administration of a cold saline bolus in superior vena cava while monitoring the corresponding temperature variation through a femoral arterial catheter equipped with a tip thermistor. Accordingly, a 5 French catheter equipped with a tip thermistor was inserted into the femoral artery.
Other intervention name(s): Picco
Observational model: Case-Only
Time perspective: Prospective
Sampling method: Non-Probability Sample
Study population: 
        We enrolled patients admitted in ICU with diagnosis of sepsis shock. Sepsis shock was
        defined as a probable infectious etiology with sequential organ failure assessment score
        (SOFA) upper than 2, arterial lactate > 2 mmol dL-1 and contextually hypotension refractory
        to the initial fluid administration followed by the use of vasoconstrictor agent to sustain
        the mean arterial pressure (MAP) > 65 mmHg.