Low systemic vascular resistance: differential diagnosis and outcome

ObjectiveTo determine the frequency and prognosis of the various causes oflow systemic vascular resistance (SVR).DesignAnalysis of consecutive patients over a 5-year period;retrospective review.SettingMedical intensive care unit of a large university hospital.PatientsFifty-five patients with unexplained hypotension and a SVR lessthan 800 dynes × s/cm5.BackgroundThere are minimal data in the medical literature determining thefrequency or outcome of patients with a low SVR that is unrelated to sepsis orthe sepsis syndrome. We retrospectively reviewed and analyzed all hemodynamicdata in a large university hospital over a 5-year period to determine thefrequency and prognosis of the various causes of low SVR. Fifty-five patientswith unexplained hypotension and a SVR less than800dynes×s/cm5were identified.Main resultsTwenty-two patients (Groups 1 and 2) met the criteria for sepsissyndrome. The mean SVR for this group was 445 ±168 dynes×s/cm5 with an associated mortality of 50%. Group 3contained 20 patients with possible sepsis. Thirteen patients (Group 4) werenonseptic. The mean SVR of this group was 435 ±180 dynes × s/cm5 with an associated mortality of 46%. Extremelylow SVR (below 450 dynes × s/cm5) was associated with asignificantly higher mortality regardless of the etiology.ConclusionsAt least a quarter of patients with hypotension and a low SVR havenonseptic etiologies. The patients with nonseptic etiologies have a similarmortality to septic patients. Clinicians should be aware of the wide spectrumof conditions that induce a low SVR.

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