Am. J. Respir. Crit. Care Med., Vol 157, No. 1, Jan 1998, 50-56.
Determination of total effective vascular compliance in patients with sepsis syndrome [In Process Citation]
F Stephan, A Novara, B Tournier, JM Maillet, GM London, ME Safar and JY Fagon
Department of Internal Medicine, INSERM U 337, Broussais Hospital, Paris, France.
Changes in capacitance vessels have important consequences on cardiac
filling pressure and fluid volume distribution in patients with sepsis
syndrome. Vascular compliance may be evaluated from the slope of the
relationship between changes in total blood volume (deltaTBV) and changes
in central venous pressure (deltaCVP) during acute volume expansion (450 ml
of gelatin fluid over 6 min), i.e., from the deltaTBV/deltaCVP ratio. The
mean ratio (ml x mm Hg-1 x kg-1) was 2.03 +/- 0.21 in control subjects,
1.43 +/- 0.25 in mechanically ventilated patients without sepsis syndrome,
and 0.94 +/- 0.24 in mechanically ventilated patients with sepsis syndrome
(p < 0.0001 versus the other two groups). Based on echocardiographic
determinations, cardiac performance was constantly found within the normal
range (cardiac output ranged from 5.6 +/- 1.2 to 6.7 +/- 2.0 L/min in
nonseptic patients from 6.8 +/- 1.9 to 7.8 +/- 2.2 in septic patients).
Effective compliance of the total vascular bed is therefore reduced in
patients with sepsis syndrome, independently of the hemodynamic
modifications due to mechanical ventilation.
