Vivid 7 dimension 06

Management of the included patients was guided by our local protocol, adapted from international guidelines [21 (link)]. In patients with septic shock, intravenous volume expansion was provided to achieve predefined endpoints: pulse pressure variation <13% [22 (link)], no response to passive leg raising [23 (link)], or no respiratory variations of the inferior vena cava diameter (assessed by echography) [24 ]. Norepinephrine was used in a stepwise manner to achieve predefined endpoints: mean arterial pressure (MAP) ≥65 mmHg and urine output ≥0.5 mL/Kg/h. All patients were investigated with transthoracic echocardiography (Vivid 7 dimension’06, GE Healthcare^®). If cardiac dysfunction was identified (left ejection fraction <30% by Simpson bi-plan methodology), inotropic therapy was introduced and/or epinephrine was used to replace norepinephrine. Mechanical ventilation was provided when needed. If required, patients were sedated with propofol and/or midazolam and analgesia was provided with sufentanil. Glycemic control and venous thrombosis prophylaxis were provided.

Management of patients with severe sepsis and septic shock was guided by our local protocol, adapted from international guidelines [15 (link)]. In patients with septic shock, intravenous volume expansion was provided to achieve predefined endpoints: pulse pressure variation <13 % [16 (link)], no response to passive leg raising [17 (link)] or no respiratory variations of the inferior vena cava diameter [18 (link)]. Norepinephrine was used in a stepwise manner to achieve predefined endpoints: mean arterial pressure (MAP) ≥65 mmHg and urine output ≥0.5 mL/kg/h. All patients were investigated with transthoracic echocardiography (Vivid 7 Dimension’06, GE, Healthcare^®). When a cardiac dysfunction (left ejection fraction <30 % by Simpson’s biplane methodology) was identified, an inotropic therapy was introduced and/or epinephrine replaced norepinephrine. Ventilation support was provided when needed. If required, patients were sedated with propofol and/or midazolam and analgesia provided with sufentanil. Use of low doses hydrocortisone (200 mg/day) was considered when there was persistence of vasopressors requirement despite a perceived adequate intravascular volume. Glycemic control and venous thrombosis prophylaxis were provided according to Surviving Sepsis Campaign Guidelines [15 (link)].

The following patients’ characteristics were recorded: age, gender, comorbidities and usual medication, the severity of illness evaluated by Simplified Acute Physiology Score II (SAPS II) and Sequential Organ Failure Assessment (SOFA) at inclusion, the onset of symptoms, respiratory support, use of vasopressor. We collected at inclusion global hemodynamic parameters (mean arterial pressure [MAP], heart rate [HR] and, cardiac index [CI]) and peripheral tissue perfusion parameters (Mottling score, skin temperature, Central-to-skin temperature gradient, arterial lactate level and urine output). Cardiac output and cardiac index were measured using transthoracic echocardiography (Vivid 7 Dimension’06, GE Healthcare). Biological parameters were also collected at inclusion. In this observational study, the Ach iontophoresis result did not imply any specific intervention or deviation from the standard of care procedures. The protocol was approved by the ethical committee of Société de Réanimation de Langue Française (CE SRLF 21–59).