Chapter 8

Septic Cardiomyopathy: an Echocardiographic Approach

Hélène Nougue, Alexandre Mebazaa and Etienne Gayat

Abstract

Septic shock is one of the most complex hemodynamic failure syndromes, and its mode of expression is highly variable and may include each one to a variable degree: absolute or relative reduction of volemia, severe peripheral vasodilatation, right and left ventricular (RV and LV) myocardial failure and global myocardial dysfunction. Because of this variability and to optimize the treatment, it seems necessary to perform echocardiography at admission in intensive care unit (ICU) for septic shock and repeat it at least once a day or more in case of hemodynamic instability. </p><p> Echocardiographic findings should be integrated with clinical data and other monitoring information, especially with those related to peripheral tissue perfusion. Transesophageal echography (TEE) enables for a complete assessment, also detailing heart-lung interactions and fine volume responsiveness evaluation but TEE is not necessarily required if the transthoracic echography (TTE) provided answers to questions. </p><p> Echocardiography allows help intensivists to establish therapeutic such as inotropes, vasopressors or to optimize volemia after volume expansion. Thus, echocardiography is now an unavoidable tool in assessing hemodynamic instability in septic shock patients. A1ccordingly, echocardiography training is crucial to help its widespread use in all ICUs.

Total Pages: 140-153 (14)

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