Management of myocardial dysfunction in severe sepsis

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.