Diastolic Shock Index and Vascular Response to Norepinephrine as Markers of Cardiovascular Dysfunction

Septic shock represents one of the main causes of mortality in critically ill patients, and its early and adequate hemodynamic management is essential to improve clinical outcomes. The Diastolic Shock Index (DSI), defined as the ratio of heart rate to diastolic blood pressure (HR/DBP), has emerged as a useful tool for early detection of cardiovascular dysfunction. This study aims to evaluate the usefulness of DSI as a marker of hypoperfusion and predictor of the need for norepinephrine in patients with sepsis or septic shock undergoing surgery under general anesthesia. A retrospective cohort study was performed in 60 patients, classifying them into two groups: those who received norepinephrine early guided by a DSI >2 (cases) and those who received it late without considering the DSI (controls). Variables such as lactate, CO₂ delta, maximum norepinephrine dose and ICU admission were analyzed. The results show that elevated DSI is associated with tissue hypoperfusion and increased vasopressor requirement. We conclude the DSI is a sensitive, easy to calculate and clinically useful marker for guiding the early initiation of norepinephrine, thereby optimizing tissue perfusion and preventing fluid overload.