title: 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.
authors.affiliation: Assistance Publique-Hôpitaux de Paris (AP-HP), CHU Bicêtre, service de réanimation médicale, Le Kremlin-Bicêtre, France.
authors.forename: Mathieu
authors.initials: M
authors.lastname: Jozwiak
authors.forename: Romain
authors.initials: R
authors.lastname: Persichini
authors.forename: Xavier
authors.initials: X
authors.lastname: Monnet
authors.forename: Jean-Louis
authors.initials: JL
authors.lastname: Teboul
mesh_terms: D000818:Animals; D015415:Biomarkers / Q000378:metabolism; D009202:Cardiomyopathies / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D002316:Cardiotonic Agents / Q000009:adverse effects / Q000627:therapeutic use; D002407:Catheterization, Swan-Ganz / Q000379:methods; D004280:Dobutamine / Q000009:adverse effects / Q000627:therapeutic use; D004452:Echocardiography; D006801:Humans; D018805:Sepsis / Q000150:complications*; D012720:Severity of Illness Index; D012772:Shock, Septic / Q000150:complications*; D013815:Thermodilution / Q000379:methods
chemical_list: D015415:Biomarkers; D002316:Cardiotonic Agents; D004280:Dobutamine