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Am. J. Respir. Crit. Care Med., Volume 160, Number 2, August 1999, 458-465

Inappropriate Sympathetic Activation at Onset of Septic Shock
A Spectral Analysis Approach

DJILLALI ANNANE, FABIEN TRABOLD, TAREK SHARSHAR, IRÈNE JARRIN, ANNE SOPHIE BLANC, JEAN CLAUDE RAPHAEL, and PHILIPPE GAJDOS

Service de Réanimation Médicale, Hôpital Raymond Poincaré, Faculté de Médecine Paris Ouest, Université Paris V, Paris, France

The autonomic cardiovascular control was investigated in 10 patients with septic shock, 10 patients with sepsis syndrome, and six tilted healthy subjects. Overall variability, high- and low-frequency components (AUC, HF, and LF, beats/min2/Hz or mm Hg2/Hz) from heart rate (HR), systolic (SBP) and diastolic (DBP) blood pressures spectra were obtained from 5-min recordings. LFHR/HFHR and the square root of LFSBP/LFHR (alpha ) were used as indices of sympathovagal interaction and baroreflex control of the heart, respectively. Compared with tilted control subjects and patients with sepsis syndrome, septic shock is characterized by reduction in: (1) HR variability, i.e., decreased AUCHR (p = 0.007), LFHR (p = 0.002), and LFHR/HFHR (p = 0.0002); (2) DBP variability, i.e., decreased AUCDBP (p = 0.003) and LFDBP (p = 0.001), (3) alpha  (p = 0.003). In septic shock, LFHR/HFHR, alpha , and LFDBP correlated with mean blood pressure (r = 0.67, p = 0.04, r = 0.64, p = 0.03, and r = 0.88, p = 0.0008, respectively), and with plasma norepinephrine levels (r = -0.65, p = 0.03, r = -0.79, p = 0.006, and r = -0.69, p = 0.03, respectively). In conclusion, onset of septic shock is characterized by high concentrations of circulating catecholamines but impaired sympathetic modulation on heart and vessels, suggesting that central autonomic regulatory impairment contributes to circulatory failure.




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Copyright © 1999 American Thoracic Society