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Right ventricular function in early septic shock states

G Redl1, P Germann, H Plattner

  • 1Department of Anaesthesiology and General Intensive Care Medicine, University of Vienna, Austria.

Intensive Care Medicine
|January 1, 1993
PubMed
Summary
This summary is machine-generated.

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In severe sepsis, a low right ventricular ejection fraction (below 45%) predicts when fluid resuscitation alone won't improve organ perfusion pressure, necessitating additional medication.

Area of Science:

  • Critical Care Medicine
  • Cardiovascular Physiology
  • Sepsis Pathophysiology

Background:

  • Severe sepsis often leads to circulatory dysfunction.
  • Fluid resuscitation is a cornerstone of sepsis management.
  • Predicting fluid responsiveness is crucial for optimizing therapy.

Purpose of the Study:

  • To identify a reliable predictor for the failure of fluid resuscitation monotherapy in severe sepsis.
  • To define a variable indicating limitations in cardiac output responsiveness.

Main Methods:

  • Prospective controlled trial in an anesthesiological ICU.
  • Included 27 patients with early septic shock (MAP < 60 mmHg).
  • Assessed hemodynamic response to fluid resuscitation using thermodilution, focusing on right heart function.

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Main Results:

  • 41% of patients (11/27) exhibited right ventricular (RV) ejection fraction < 45%.
  • In these patients, fluid resuscitation (2850 +/- 210 ml crystalloids) did not sufficiently improve mean arterial pressure (MAP).
  • Inotropic and/or vasoactive drugs were required to maintain MAP > 60 mmHg.

Conclusions:

  • Right ventricular dysfunction is prevalent in early septic shock.
  • Fluid replacement alone is insufficient for hemodynamic stabilization in patients with RV dysfunction.
  • Catecholamine therapy is often necessary when RV dysfunction limits fluid responsiveness.