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
