Description of the Early Hemodynamic Profile of Septic Patients Assessed by Focused Echocardiography in the Emergency Department

Abstract

Introduction: Identification of hemodynamic profile of septic patients in the Emergency Department (ED) could allow early tailoring recommendations of the Surviving Sepsis Campaign (SSC). The study aims at describing early hemodynamic profiles encountered in septic patients using focused echocardiography and their therapeutic impact. Methods: We prospectively enrolled adult patients admitted to the ED with sepsis (qSOFA [quick Sepsis-related Organ Failure Assessment] ≥ 2) during a 30-month period. Echocardiography was performed by emergency physicians trained to Critical Care Ultrasound level 1. Investigators determined the hemodynamic profile based on simple yet robust criteria (hypovolemia, vasoplegia with hyperdynamic state, ventricular failure, or apparently normal profile). Therapeutic impact was defined by the number of patients for whom early echocardiography modified SSC-based therapy. Results: Echocardiography was performed in 81 patients (mean age: 70 ± 15 years; men [N = 47, 58%]; SOFA = 5.3 ± 2.9; lactates = 4.6 ± 4.2 mmol/l; Intensive Care Unit admission (N = 30, 38%]; Day-28 mortality [N = 28, 35%]) after a median fluid loading of 500 ml (interquartile range: 500–1500 ml). Forty four patients had sepsis and 37 sustained septic shock. Hemodynamic profiles were hypovolemia in 54 patients (67%), potentially associated with vasoplegia in 26 patients (32%), and ventricular failure in 21 patients (26%). Ongoing therapy was altered based on early echocardiographic assessment in 26% of cases (N = 21), including discontinuation of fluid resuscitation after a median volume of 850 ± 740 ml in 8 patients. Conclusion: Early ventricular dysfunction involved more than 20% of septic patients in the ED. Whether tailored therapeutic management guided by focused echocardiographic assessment impacts patient-centered outcome remains to be determined.