• Anthony M Napoli, Keith Corl, Fenwick Gardiner, and Ahteri Forcada.
• Department of Emergency Medicine, Brown University Medical School, Providence, RI 02903, USA. anapoli@lifespan.org
• J Crit Care. 2011 Feb 1;26(1):47-53.

PurposeReversible ventricular dysfunction is common in sepsis. Impedance cardiography allows for noninvasive measurement of contractility through time interval or amplitude-based measures. This study evaluates the prognostic capacity of these measures in patients with severe sepsis or septic shock in the emergency department.MethodsThis is a prospective observational cohort study of 56 patients older than 18 years meeting criteria for early goal-directed therapy (lactate level >4 mmol/L or systolic blood pressure <90 mm Hg after 2-L isotonic sodium chloride solution). Continuous collections of contractility measures were performed, and patients were followed until discharge or in-hospital death.ResultsA significant 57% reduction in the accelerated contractility index (ACI) in nonsurvivors (71 1/s(2) [41-102]) compared with survivors (123 1/s(2) [98-147]) existed. Only ACI predicted in-hospital mortality (area under the receiver operating characteristic curve = 0.70, P < .01). Accelerated contractility index did not correlate with amount of prior fluid administration, central venous pressure, number of cardiac risk factors, or troponin I value. An ACI of less than 40 1/s(2) is 95% (84-99) specific with a positive likelihood ratio of 8.8 for predicting in-hospital mortality.ConclusionsA reduced ACI is associated with mortality in critically ill emergency department patients presenting with severe sepsis and septic shock meeting criteria for early goal-directed therapy. This association appears to be independent of clinical or laboratory predictors of cardiac dysfunction or preload.Copyright © 2011 Elsevier Inc. All rights reserved.

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