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Right ventricular dysfunction in septic patients
T Mitsuo1, S Shimazaki, H Matsuda
1Department of Critical Care Medicine and Traumatology, Kyorin University Hospital, Tokyo, Japan.
Objective:
To compare right ventricular ejection fraction in trauma and septic patients during the hyperdynamic circulatory phase of these states.
Design:
Prospective, consecutive study.
Setting:
University hospital ICU.
Patients:
Eleven trauma patients (group 1) and ten septic patients (group 2) were studied. Patients with circulatory shock were excluded from the study.
Interventions:
Right ventricular ejection fraction was measured with a modified pulmonary artery catheter using the thermodilution method. Patients requiring catecholamines to maintain a systolic BP greater than 90 mm Hg were excluded from the study.
Measurements And Main Results:
Both groups 1 and 2 had high mean cardiac output values (cardiac indices 4.7 +/- 0.9 [SD] and 4.6 +/- 1.4 L/min/m2, respectively). Right ventricular ejection fraction was significantly (p less than .005) reduced in septic patients (47 +/- 7.0% vs. 36 +/- 9.7%; group 1 vs. group 2) and end-diastolic volume index was significantly (p less than .01) increased (101 +/- 34 vs. 122 +/- 40 mL/m2; group 1 vs. group 2) in comparison with the trauma patients. However, there were no significant differences in afterload between the two groups.
Conclusions:
Hemodynamic measurements comparing septic and trauma patients showed increased cardiac output in both groups and no differences in the pulmonary resistance. Right ventricular ejection fraction in the septic patients was significantly reduced compared with the trauma patients. Therefore, we concluded that right ventricular contractility may be decreased in septic patients.