Hemodynamic Heterogeneity in Community-Acquired Sepsis at Intermediate Care Admission: A Prospective Pilot Study...

Area of Science:

• Critical Care Medicine
• Cardiovascular Physiology
• Sepsis Pathophysiology

Background:

• Sepsis presents heterogeneously, with similar clinical signs masking diverse hemodynamic states.
• Standard macroscopic assessments may not capture underlying perfusion abnormalities in sepsis.
• Understanding hemodynamic profiles is crucial for effective sepsis management.

Purpose of the Study:

• To characterize hemodynamic profiles in community-acquired sepsis.
• To correlate hemodynamic profiles with macro-hemodynamic indices (SOFA, MAP).
• To compare fluid responders and non-responders and assess prognostic value of early distributive shock identification.

Main Methods:

• Prospective observational pilot study in an Intermediate Medical Care Unit (IMCU).
• 115 adult patients with community-acquired sepsis assessed using NICaS® bioimpedance.
• Hemodynamic indices analyzed against SOFA score, MAP, fluid responsiveness, and 30-day mortality.

Main Results:

• Hemodynamics were heterogeneous, with poor correlation between SOFA and key hemodynamic indices (SV, SI, CO, CI).
• MAP correlated with total peripheral resistance (TPR) and cardiac index (CI), but not stroke volume (SV) or cardiac output (CO).
• A distributive shock profile was identified in 21.7% of patients, often with normal MAP, and was not linked to mortality.

Conclusions:

• Macro-indices (SOFA, MAP) inadequately represent the hemodynamic state in sepsis.
• Early noninvasive hemodynamic profiling reveals significant circulatory heterogeneity.
• Findings support individualized resuscitation strategies and warrant further interventional research.