Should I Give My Patient with Septic Cardiomyopathy Fluids?
The incidence of acute LV dysfunction in septic shock is estimated to occur in 18 - 46% of patients within the first 24 hours of shock. Unlike the "classic" pattern of cardiogenic shock where LV filling pressure is high, in septic shock there are normal or low LV filling pressures.
Three therapeutic options should be strongly considered in the patient with a septic cardiomyopathy [CM]:
FLUIDS: Most patients with septic CM need fluids to restore adequate preload/afterload. Severe vasoplegia requires volume resuscitation - even if the bedside ECHO suggests reduced contractility. Give fluids generously.
Vasopressors: Catecholamine supplementation (norepi) improves patient's preload & afterload, but can often unmask septic CM. Consider epinephrine as a second line agent (over vasopressin) for inotropic support.
Inotropes: Consider adding epinephrine (1 to 5 mcg/min) or dobutamine (start at 1-5 mcg/kg/min) to target an improved cardiac index (>2.5 L/min/m2) or ScVO2 > 70%.
