16 | The PEECS study: PiCCO-echocardiographic evaluation of cardiomyopathy in septic shock

Background. We conducted a prospective observational study conducted in two tertiary hospital ICUs to evaluate heart hemodynamics in septic shock. The primary objective is to evaluate the relationship between Arterial Compliance Pressure (ACP) measured by the PiCCO system and Ventricular-Arterial (VA) coupling obtained by echocardiography to predict Septic Cardiomyopathy (SCM) within the first 48 hours of septic shock diagnosis.

Methods. The study enrolled 13 adult patients diagnosed with septic shock, undergoing semi-invasive hemodynamic monitoring (PiCCO, MostCare) within the first 48 hours. Patients were evaluated at baseline (<12h from diagnosis), 72 hours, and 7 days. Data collected included demographic information, clinical parameters, and echocardiographic measurements. ACP was calculated as a percentage value of the ratio between Cardiac Index (CI) measured with the PiCCO system and predicted CI. Echocardiographic evaluation focused on systolic and diastolic function of the cardiac sections and VA coupling.

Results. At baseline, 30.77% of patients met the criteria for SCM, which increased to 38.6% at three days. By the seventh day, an improvement in hemodynamic parameters was observed in 62% of patients. The study found a significant association between ACP and VA coupling at baseline (R²=0.34; p=0.003). Both ACP and VA coupling metrics were valid in predicting SCM, with ACP showing a slightly higher area under the ROC curve. The study also noted a trend of improvement in both PiCCO and echocardiographic parameters over the seven days.

Conclusions. The preliminary findings suggest that both ACP and VA coupling are effective in predicting SCM in septic shock patients. The improvement in hemodynamic parameters over seven days indicates potential for better patient outcomes with early and accurate monitoring. Further research with a larger sample size is needed to validate these results.