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Semin Respir Crit Care Med 2011; 32(2): 206-214
DOI: 10.1055/s-0031-1275533
© Thieme Medical Publishers

Management of Myocardial Dysfunction in Severe Sepsis

Mathieu Jozwiak1 , Romain Persichini1 , Xavier Monnet1 , 2 , Jean-Louis Teboul1 , 2
  • 1Assistance Publique-Hôpitaux de Paris (AP-HP), CHU Bicêtre, service de réanimation médicale, Le Kremlin-Bicêtre, France
  • 2Université Paris-Sud, Faculté de médecine Paris-Sud, Le Kremlin-Bicêtre, France
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Publikationsdatum:
19. April 2011 (online)

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ABSTRACT

Sepsis-induced cardiac dysfunction is a frequent and severe complication of septic shock. The mechanisms responsible for its development are complex and intricate. Echocardiography is the best method to make the diagnosis of cardiac dysfunction. Biomarkers (B-type natriuretic peptides and cardiac troponins) can alert clinicians of the possibility of cardiac dysfunction. Low plasma levels can serve to rule out a severe cardiac dysfunction. By contrast, high levels should prompt the performance of an echocardiographic examination. The transpulmonary thermodilution monitor and the pulmonary artery catheter can also be used to alert clinicians or to monitor the effects of inotropic therapy. Dobutamine is the first-line therapy. Its administration remains a matter of debate and should be carefully monitored in terms of efficacy and tolerance.

KEYWORDS

Sepsis - myocardial depression - echocardiography - B-type natriuretic peptide - dobutamine - levosimendan

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Jean-Louis TeboulM.D. Ph.D. 

Service de réanimation médicale, CHU Bicêtre

78, rue du Général Leclerc, 94 270 Le Kremlin-Bicêtre, France

eMail: jean-louis.teboul@bct.aphp.fr