Profound but Reversible Myocardial Depression in Patients with Septic Shock

Abstract

To characterize the role of cardiac function in septic shock, serial radionuclide cineangiographic and hemodynamic evaluations were done on 20 patients with documented septic shock. Although all patients had a normal or elevated cardiac index, 10 patients had moderate to severe depression of their ejection fraction with values below 0.40. Thirteen of twenty patients survived their episode. Paradoxically, 10 of 13 survivors, but none of the 7 nonsurvivors, had an initial ejection fraction less than 0.40 (p less than 0.005). The mean initial ejection fraction for the survivors was 0.32 +/- 0.04, and their mean end systolic and end diastolic ventricular volumes were substantially increased with a normal stroke volume. The survivors' serial scans showed a gradual return to normal ejection fraction and ventricular volume by 10 days after the onset of shock. Nonsurvivors had normal initial ejection fractions and ventricular volumes that did not change during serial studies.

Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016

“…A large randomized trial and meta-analysis comparing low-dose dopamine to placebo found no difference in need for RRT, urine output, time to renal recovery, survival, ICU stay, hospital stay, or arrhythmias [282,283]. Thus, the available data do not support administration of low doses of dopamine solely to maintain renal function.…”

The Japanese Clinical Practice Guidelines for Management of Sepsis and Septic Shock 2016 (J‐SSCG2016)

“…In septic shock, despite appropriate fluid resuscitation and noradrenaline administration, the following factors can create difficulty in maintaining hemodynamics: (i) difficulty in controlling peripheral vascular resistance accompanying vasodilatation (relative hypovolemic shock)119 and (ii) cardiac dysfunction associated with SIMD (cardiogenic shock) 113, 114. These pathologies can be distinguished relatively easily through echocardiography.…”

The haemodynamics of human septic shock*

“…Both left and right ventricular dysfunction have been demonstrated in patients with sepsis using the ventricular stroke work index (SWI) [152], the depressed relationship between left ventricular SWI and CVP [119] or pulmonary artery wedge pressure (PAWP) [127,134], radionuclide blood-pool scan [153] and twodimensional echocardiography [154]. It has usually been associated with hypodynamic as opposed to hyperdynamic septic shock [119,152], and failure to survive [127,156].…”