[Myocardial incompetence in meningococcal purpura in children. Early hemodynamic study]

In order to investigate the haemodynamic changes involved at the very beginning of meningococcal purpura fulminans, a prospective study was conducted in 10 children in whom a Swan-Ganz catheter was introduced on admission into the pulmonary artery. The first measurements performed 6 to 14 hours (mean: 10.2h) after the first signs of purpura were detected showed in every case a state of shock with fall in tissue oxygen consumption values and reduction of ventricular performance, although the systemic blood pressure was preserved and the central venous pressure was normal. In patients admitted at an early stage, 4 to 6 hours after the onset and directly from home, hypovolaemia predominated and masked the myocardial insufficiency. Patients referred by another hospital and whose hypovolaemia had already been corrected (i.e. 9 to 12 h after the onset) had full myocardial incompetence with fall in cardiac index, rise in capillary pressure and lowering of the ventricular function curve. Under beta-adrenergic stimulants combined with re-expansion of blood volume according to haemodynamic variations, the state of shock was reversed within 48 to 72 hours, and all patients in this series survived. These findings confirm that myocardial incompetence is constant and occurs at an early stage of purpura fulminans.