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Monitoring Myocardial Dysfunction as Part of Sepsis Management

  • Olfa Hamzaoui
  • Jean-Louis TeboulEmail author
Chapter
  • 2k Downloads

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.

Keywords

Left Ventricular Ejection Fraction Cardiac Dysfunction Pulmonary Artery Catheter Transpulmonary Thermodilution Pulse Contour Analysis 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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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Copyright information

© Springer-Verlag Berlin Heidelberg 2012

Authors and Affiliations

  1. 1.Service de réanimation médicale, Hôpital Antoine Béclère, Assistance Publique–Hôpitaux de ParisUniversité Paris-Sud 11ClamartFrance
  2. 2.Service de réanimation médicaleCentre Hospitalier Universitaire de BicêtreParisFrance

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