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Monitoring Myocardial Dysfunction as Part of Sepsis Management

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Sepsis Management

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Abstract

Sepsis-induced cardiac dysfunction occurs early in the course of severe sepsis. The mechanisms responsible for its development are complex and intricate. The degree of severity of septic myocardial depression is variable from patient to patient. Doppler echocardiography is the best method to make the diagnosis of cardiac dysfunction (a decrease in left ventricular ejection fraction). The transpulmonary thermodilution monitor (decrease in cardiac function index, decrease in cardiac output) and the pulmonary artery catheter (decrease in cardiac output and/or decrease in mixed venous oxygen saturation) can be used either to alert clinicians of the possibility of cardiac dysfunction or to monitor the effects of inotropic therapy. Low plasma levels of B-type natriuretic peptide levels can serve to rule out severe cardiac dysfunction. In contrast, high levels of natriuretic peptides do not allow diagnosing myocardial depression with certainty and should prompt the performance of echocardiographic examination. Administration of inotropic drugs, such as β1-agonist agents, is a matter of debate and should be carefully monitored in terms of efficacy as well as tolerance.

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Abbreviations

A:

Peak Doppler velocity of late diastolic flow

BNP:

B-type natriuretic peptide

CFI:

Cardiac function index

cTnI:

Cardiac troponin I

cTnT:

Cardiac troponin T

E:

Peak Doppler velocity of early diastolic flow

Ea:

Early diastolic mitral annular velocity

GEDV:

Global end-diastolic volume

LVEF:

Left ventricular ejection fraction

NO:

Nitric oxide

NT-proBNP:

N terminal proBNP

PAC:

Pulmonary artery catheter

PAOP:

Pulmonary artery occlusion pressure

PEEP:

Positive end-expiratory pressure

ScvO2 :

Central venous blood oxygen saturation

SvO2 :

Mixed venous blood oxygen saturation

VTIAo:

Velocity-time integral of aortic blood flow

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Author information

Authors and Affiliations

  1. Service de réanimation médicale, Hôpital Antoine Béclère, Assistance Publique–Hôpitaux de Paris, Université Paris-Sud 11, Clamart, France

    Olfa Hamzaoui

  2. Service de réanimation médicale, Centre Hospitalier Universitaire de Bicêtre, Le Kremlin-Bicêtre, Paris, France

    Jean-Louis Teboul

Authors
  1. Olfa Hamzaoui
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  2. Jean-Louis Teboul
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Correspondence to Jean-Louis Teboul .

Editor information

Editors and Affiliations

  1. Unidad de Cuidados Críticos, Hospital Universitari Joan XXIII, Carrer Mallafré Guasch 4, Tarragona, 43007, Spain

    Jordi Rello

  2. Intensive Care Facility, Royal Brisbane Hospital, Herston Road, Herston, Brisbane, 4029, Queensland, Australia

    J. Lipman

  3. Unidad de Cuidados Críticos, Hospital Universitari Joan XXIII, Carrer Mallafré Guasch 4, Tarragona, 43007, Spain

    Thiago Lisboa

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Hamzaoui, O., Teboul, JL. (2012). Monitoring Myocardial Dysfunction as Part of Sepsis Management. In: Rello, J., Lipman, J., Lisboa, T. (eds) Sepsis Management. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-03519-7_8

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  • DOI: https://doi.org/10.1007/978-3-642-03519-7_8

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  • Print ISBN: 978-3-642-03518-0

  • Online ISBN: 978-3-642-03519-7

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