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Critical Care

, 17:R96

First Online: 27 May 2013Received: 03 December 2012Revised: 03 April 2013Accepted: 27 May 2013

Abstract

IntroductionReversible myocardial depression occurs early in severe sepsis and septic shock. The question of whether or not early ventricular depression or dilatation is associated with lower mortality in these patients remains controversial. Most studies on this topic were small in size and hence lacked statistical power to answer the question. This meta-analysis attempted to answer the question by increasing the sample size via pooling relevant studies together.

MethodsPubMed, Embase and Medline databases and conference abstracts were searched to July 2012 for primary studies using well-defined criteria. Two authors independently screened and selected studies. Eligible studies were appraised using defined criteria. Additional information was sought the corresponding authors if necessary. Study results were pooled using random effects models. Standardized mean differences SMD between survivor and non-survivor groups were used as the main effect measures.

ResultsA total of 62 citations were found. Fourteen studies were included in the analysis. The most apparent differences between the studies were sample sizes and exclusion criteria. All studies, except four pre-1992 studies, adopted the Consensus definition of sepsis. Altogether, there were >700 patients available for analysis of the left ventricle and >400 for the right ventricle. There were no significant differences in left ventricular ejection fractions, right ventricular ejection fractions, and right ventricular dimensions between the survivor and non-survivor groups. When indexed against body surface area or body height, the survivors and non-survivors had similar left ventricular dimensions. However, the survivors had larger non-indexed left ventricular dimensions.

ConclusionThis meta-analysis failed to find any evidence to support the view that the survivors from severe sepsis or septic shock had lower ejection fractions. However, non-indexed left ventricular dimensions were mildly increased in the survivor group but the indexed dimensions were similar between the groups. Both survivors and non-survivors had similar right ventricular dimensions.

AbbreviationsBSAbody surface area

EFejection fraction

ICUintensive care unit

LVleft ventricle

LVEDDleft ventricular end-diastolic diameter

LVEDVleft ventricular end-diastolic volume

RVright ventricle

RVEDAright ventricular end-diastolic area

RVEDDright ventricular end-diastolic diameter

RVEDVright ventricular end-diastolic volume

SIRSsystemic inflammatory response syndrome

SMDstandardized mean difference.

Electronic supplementary materialThe online version of this article doi:10.1186-cc12741 contains supplementary material, which is available to authorized users.

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Autor: Stephen J Huang - Marek Nalos - Anthony S McLean

Fuente: https://link.springer.com/



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