Right ventricular function of patients with septic shock: clinical significance

To understand the effect of right ventricular dysfunction on circulatory supportive therapy in patients with septic shock.

25 patients with septic shock who were admitted consecutively to the intensive care unit (ICU) of Peking Union Medical College Hospital were observed prospectively. Hemodynamic profile of the left side and right side heart was monitored with right ventricular ejection fraction catheter and transthoracic echocardiography. Intramucosal pH (pHi) and oxygen delivery were also monitored to illustrate any relation with patient outcome.

Stroke volume index (SVI) and right ventricular ejection fraction (RVEF) were significantly higher in survivors than in nonsurvivors (P < 0.01 and < 0.05, respectively). The pulmonary vascular resistance index (PVRI) was significantly lower in survivors (P < 0.01). At the onset of shock, the left ventricular end-diastolic volume index (LVEDVI) of both groups was very low, and steadily increased in survivors but not in nonsurvivors. Left ventricular ejection fraction (LVEF) and systemic vascular resistance index (SVRI) decreased during treatment, which were not different in both groups. Right ventricular end-diastolic volume index (RVEDVI) increased in both survivors and nonsurvivors. Oxygen delivery of nonsurvivors was significantly lower than that of survivors. LVEDVI and RVEF were correlated with SVI in both survivors and nonsurvivors.

The impairment of right heart function may be more severe than that of left heart function in the patients with early septic shock. "Right heart priority" must be seriously considered in supportive treatment of patients with septic shock. The present treatment of septic shock has significant limitations, and even aggravates the existing cardiac dysfunction.