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Related Experiment Videos

Unsuspected right ventricular dysfunction in shock and sepsis.

M J Hoffman, L J Greenfield, H J Sugerman

    Annals of Surgery
    |September 1, 1983
    PubMed
    Summary
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    Right ventricular dysfunction is common after shock resuscitation and impacts survival. Improving right ventricular function, measured by cardiac scintigraphy, is key to patient survival.

    Area of Science:

    • Cardiology
    • Critical Care Medicine
    • Physiology

    Background:

    • Ventricular function monitoring is crucial in shock resuscitation.
    • Central venous pressure (CVP) and pulmonary wedge pressure (PCW) are common but may not fully reflect ventricular performance.
    • Hypovolemic and septic shock can lead to significant cardiac dysfunction.

    Purpose of the Study:

    • To compare hemodynamic monitoring (CVP, PCW) with ventricular function assessment (ejection fraction, end-diastolic volume) post-resuscitation.
    • To investigate the relationship between ventricular dysfunction and patient outcomes in shock.
    • To identify predictors of survival following resuscitation from hypovolemic and septic shock.

    Main Methods:

    • Gated pool scans were used to measure right ventricular ejection fraction (RVEF) and end-diastolic volume (RVEDVI), and left ventricular ejection fraction (LVEF) and end-diastolic volume (LVEDVI).

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  • Patients were categorized into groups based on shock etiology and ventricular function post-resuscitation.
  • Hemodynamic pressures (CVP, PCW) were recorded and correlated with ventricular volumes and ejection fractions.

    • Main Results:

    • All 16 patients showed depressed RVEF and/or increased RVEDVI post-resuscitation.
    • Group I (hypovolemia and sepsis) had low RVEF and high RVEDVI with near-normal left ventricular function; mortality was 25%.
    • Groups II and III (sepsis or hypovolemia and sepsis) had higher mortality (80-100%) and showed biventricular depression or preserved RVEF with high RVEDVI and LVEDVI.
    • Follow-up showed improvement in RV function correlated with survival; non-survivors had significantly higher RVEDVI and RV stroke work index.
    • No correlation was found between CVP/PCW and ventricular volumes; RVEF negatively correlated with pulmonary vascular resistance.

    Conclusions:

    • Right ventricular dysfunction is prevalent after hypovolemic and septic shock resuscitation, often unrelated to filling pressures.
    • RV dysfunction is linked to myocardial ischemia and increased pulmonary vascular resistance.
    • Improvement in RV performance, detectable by cardiac scintigraphy, is critical for survival in shock patients.