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Low systemic vascular resistance: differential diagnosis and outcome |
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| Authors: | Jairo Melo Jay I Peters |
| Affiliation: | (1) Department of Medicine, Division of PulmonaryDiseases/Critical Care Medicine, The University of Texas Health Science Centerat San Antonio, Texas, USA;(2) The South Texas Veterans Health Care System, Audie L.Murphy Memorial Veterans Hospital Division, San Antonio, Texas, USA; |
| Abstract: | OBJECTIVE: To determine the frequency and prognosis of the various causes of low systemic vascular resistance (SVR). DESIGN: Analysis of consecutive patients over a 5-year period; retrospective review. SETTING: Medical intensive care unit of a large university hospital. PATIENTS: Fifty-five patients with unexplained hypotension and a SVR less than 800 dynes x s/cm5. BACKGROUND: There are minimal data in the medical literature determining the frequency or outcome of patients with a low SVR that is unrelated to sepsis or the sepsis syndrome. We retrospectively reviewed and analyzed all hemodynamic data in a large university hospital over a 5-year period to determine the frequency and prognosis of the various causes of low SVR. Fifty-five patients with unexplained hypotension and a SVR less than 800dynesxs/cm5were identified. MAIN RESULTS: Twenty-two patients (Groups 1 and 2) met the criteria for sepsis syndrome. The mean SVR for this group was 445 +/- 168 dynesxs/cm5 with an associated mortality of 50%. Group 3 contained 20 patients with possible sepsis. Thirteen patients (Group 4) were nonseptic. The mean SVR of this group was 435 +/- 180 dynes x s/cm5 with an associated mortality of 46%. Extremely low SVR (below 450 dynes x s/cm5) was associated with a significantly higher mortality regardless of the etiology. CONCLUSIONS: At least a quarter of patients with hypotension and a low SVR have nonseptic etiologies. The patients with nonseptic etiologies have a similar mortality to septic patients. Clinicians should be aware of the wide spectrum of conditions that induce a low SVR. |
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