Right ventricular performance in septic shock: A combined radionuclide and hemodynamic study

Abstract

Twenty-five patients with septic shock underwent simultaneous radionuclide ventriculography and right heart catheterization to clarify the role of the right ventricle in this syndrome. A depressed right ventricular ejection fraction (less than 38%) was present in 13 patients and was found in patients with elevated cardiac output (4 of 6 patients) and with normal or low cardiac output (9 of 19 patients). Right ventricular dysfunction was seen with or without acute respiratory failure. In eight patients, a depressed right ventricular ejection fraction was seen in combination with an abnormal left ventricular ejection fraction (less than 48%), but in five patients, right ventricular ejection fraction impairment occurred with normal left ventricular ejection fraction. There was no significant correlation between abnormal right ventricular afterload and depressed right ventricular ejection fraction. No clinical or hemodynamic finding could be used to identify patients with diminished right ventricular ejection fraction. On follow-up study in 17 surviving patients, right ventricular ejection fraction improved in 6 and was unchanged in 11. Improvement in right ventricular ejection fraction occurred more frequently in patients without pulmonary hypertension or respiratory distress. The results suggest that right ventricular dysfunction in septic shock may be more common than previously suspected. It may be caused by abnormalities in right ventricular afterload in some patients and depressed myocardial contractility in others. The findings are of therapeutic importance since interventions that diminish right ventricular afterload and increase right ventricular contractility would be appropriate in patients with septic shock and right ventricular dysfunction.

Effects of U-46619 on Pulmonary Hemodynamics Before and After Administration of BM-573, a Novel Thromboxane A2 Inhibitor

“…In septic shock, right heart failure can lead to death (Kimchi et al, 1984) and, in pulmonary embolism, most patients who succumb do so within minutes to few hours after onset of symptoms. Therefore drugs that antagonise vasoconstrictive mediators could be effective overall if given in the initial phase of hemodynamic instability.…”

Monitorage hémodynamique de l’état de choc septique

“…C'est lors de l'augmentation de la postcharge du VD, à l'occasion de la mise sous ventilation mécanique ou lors de la vasoconstriction pulmonaire hypoxique ou du sepsis, que la défaillance systolique du coeur droit se démasque. Cette défaillance survient dans plus de la moitié des cas de sepsis si l'on prend la fraction d'éjection du VD [55,56], mais dans moins de 20 % des cas si l'on prend comme indice de défaillance du VD le ratio des diamètres télédiastoliques du VD sur le VG, supérieur à 0,6 [29]. Un ratio VD/VG > 1 signe une dilatation majeure du VD.…”

Effects of epinephrine on right ventricular function in patients with severe septic shock and right ventricular failure: a preliminary descriptive study

“…Improvement in these physiologic parameters was also reported when epinephrine was used as a first-line agent [10]. Although right ventricular dysfunction is frequently documented in septic shock [2,[11][12][13][14][15][16][17] and could be considered as a prognostic factor [14,18], few studies have reported therapeutic interventions such as fluid loading [13,17] or the use of catecholamines [18,19], and no study has investigated the effects of or the possible advantage of epinephrine on right ventricular dysfunction.…”

“…The main hemodynamic disturbances of septic shock include decreased systemic vascular resistance, hypovolemia, tachycardia, and elevated cardiac output after volume loading, despite left [1] and right [2] ventricular dysfunction. In addition to appropriate antimicrobial therapy and surgery as needed, the treatment of septic shock is based on volume expansion and infusion of catecholamines such as dopamine, dobutamine [3][4][5], and norepinephrine [6].…”