Why the study?
Sepsis can cause myocardial depression affecting the right ventricle, which is poorly prepared to compensate for acute overload, and optimal fluid management strategies are critical but complex.
Case Report (n=1)
Highlights the importance of assessing RV function with echocardiography and guiding fluid therapy with CVP in septic patients with inadequate cardiac output.
Sepsis could produce myocardial depression and typically it affects the left ventricle (LV). Sepsis could also affect right ventricle (RV), in addition to the interdependence with LV. RV pressure may be elevated secondary to pulmonary vasoconstriction, leading to RV dysfunction. Unlike LV, RV is poorly prepared to compensate for acute overload. Aggressive volume replacement may be vital to maintain RV function, but excess hydration can cause RV dilation, decreased LV diastolic filling, and reduced cardiac output. In patients having signs of inadequate cardiac output even after initial volume resuscitation, RV function should be assessed with echocardiogram. If RV dysfunction is noted, then fluid therapy should be guided by CVP measurements. If cardiac output increases with increasing CVP, maintaining higher filling pressures on the right side is indicated. On the other hand, increasing CVP with worsening of the cardiac output could worsen the RV dysfunction. In addition to the fluid management, treatment of other reversible causes like acidosis and hypoxia is also a key.
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Umashankar Lakshmanadoss (2011) conducted a case report in Sepsis-induced right ventricular failure and pulmonary hypertension (n=1). Broad spectrum antibiotics, intravenous fluids, and dopamine infusion was evaluated on Clinical recovery and improvement of pulmonary hypertension and RV dilatation.
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