Acute Right Ventricular Failure Triggered by Excessive Fluid Resuscitation in Septic Shock

Area of Science:

• Critical Care Medicine
• Cardiology
• Emergency Medicine

Background:

• Septic shock resuscitation requires careful fluid management to address hypovolemia and vasoplegia.
• Excessive fluid administration can lead to right ventricular (RV) dilation and dysfunction, a critical but often overlooked complication.
• Recognizing and managing fluid-induced RV failure is essential for improving patient outcomes.

Purpose of the Study:

• To highlight the potential for acute right ventricular (RV) failure as a complication of aggressive fluid resuscitation in septic shock.
• To emphasize the utility of bedside echocardiography in diagnosing fluid-induced RV dysfunction.
• To underscore the importance of early recognition and de-resuscitation in managing RV failure.

Main Methods:

• Case report of a 68-year-old postoperative patient with abdominal sepsis.
• Hemodynamic monitoring and fluid administration (10 L crystalloid).
• Bedside echocardiography to assess RV size, function, and inferior vena cava (IVC) diameter and collapsibility.

Main Results:

• The patient developed severe RV dilation with a D-sign, reduced tricuspid annular plane systolic excursion (TAPSE) of 10 mm, and a plethoric, non-collapsing IVC (28 mm).
• De-resuscitation with diuretics and vasopressors led to transient hemodynamic improvement.
• The patient ultimately succumbed to recurrent sepsis due to an anastomotic leak.

Conclusions:

• Fluid-induced right ventricular (RV) failure can occur silently during septic shock resuscitation.
• Early echocardiographic monitoring may facilitate earlier diagnosis and intervention, potentially preventing hemodynamic collapse.
• Prompt de-resuscitation strategies are vital in managing fluid overload-related RV dysfunction.