Right ventricular function in early septic shock states.

OBJECTIVES

To define a variable which could reliably predict when fluid resuscitation as monotherapy is not expected to improve organ perfusion pressure, owing to limitations in cardiac output responsiveness in patients with severe sepsis.

DESIGN

Prospective controlled trial.

SETTING

Anesthesiological ICU in a university hospital.

PATIENTS

Twenty seven patients in early septic shock states (MAP < 60 mmHg).

INTERVENTIONS

Infusion therapy was titrated until no further increase in cardiac index and mean arterial pressure could be achieved. Fluid resuscitation as monotherapy was deemed unsuccessful at the end of 2 h if inotropic or vasoactive pharmacologic support was required to maintain a mean arterial pressure > 60 mmHg.

MEASUREMENTS AND RESULTS

We investigated the hemodynamic course during fluid resuscitation (2850 +/- 210 ml crystalloids) with special emphasis on right heart function using the thermodilution technique. Eleven patients (group A) had a right ventricular (RV) ejection fraction below 45%. In this group positive inotropic and/or vasoactive drugs were obligatory to achieve and maintain a sufficient perfusion pressure (MAP > 60 mmHg) after fluid challenge.

CONCLUSIONS

In 27 septic shock patients investigated, we diagnosed right ventricular dysfunction in 41%. In this specific patient population fluid replacement alone did not succeed in stabilizing hemodynamic variables, therefore necessitating catecholamine therapy.