From the Guidelines
For patients in septic shock, the IAPB may be used to improve CO (cardiac output). The IAPB works by inflating during diastole and deflating during systole, which enhances coronary perfusion and reduces left ventricular afterload. This mechanism helps to increase cardiac output in critically ill patients with compromised cardiac function, which is often seen in septic shock where myocardial depression can occur, as supported by the Surviving Sepsis Campaign guidelines 1. By improving cardiac output, the IAPB helps deliver more oxygen and nutrients to tissues throughout the body, potentially improving organ perfusion and function in septic patients.
While the IAPB can indirectly affect other parameters like MAP (mean arterial pressure) and potentially central venous pressure through its effects on cardiac function, its primary hemodynamic benefit in septic shock is the improvement of cardiac output, which is often compromised due to sepsis-induced myocardial depression. The guidelines emphasize the importance of initial fluid resuscitation and the use of functional hemodynamic measurements to guide further fluid administration 1. However, the use of IAPB is specifically tailored towards improving cardiac output, making it a valuable tool in the management of septic shock when cardiac function is compromised.
Key points to consider in the management of septic shock include:
- Early effective fluid resuscitation to stabilize sepsis-induced tissue hypoperfusion or septic shock 1
- The use of functional hemodynamic measurements to guide fluid administration, rather than static measurements like CVP alone 1
- The potential benefits of IAPB in improving cardiac output in patients with compromised cardiac function due to septic shock
- The importance of ongoing reevaluation of the patient's response to treatment, including the use of echocardiography and other physiologic variables to describe the patient's clinical state 1
From the Research
Improvement of Hemodynamic Parameters
The use of Intra-Aortic Balloon Pump (IABP) in patients with septic shock may improve several hemodynamic parameters, including:
- Mean Arterial Pressure (MAP) 2
- Cardiac Index (CI) 2
- Cardiac Output (CO) can be inferred to be improved as CI is improved, which is a component of CO
Effects on Oxygen Saturation and Central Venous Pressure
There is no direct evidence in the provided studies to suggest that IABP improves oxygen saturation or central venous pressure in patients with septic shock. However, the improvement in cardiac index and mean arterial pressure may have indirect effects on oxygen delivery and overall hemodynamic stability.
Clinical Value of IABP
The use of IABP in patients with septic shock has been shown to have important clinical value, including: