Right Ventricular Dysfunction in Septic Shock
Surat Tongyoo MD*, Chairat Permpikul MD*, Supaporn Lertsawangwong MD*, Aekarin Poompichet MD*, Amrung Leawruxoran MD*, Warakarn Vilaichone MD*, Ranistha Ratanarat MD*
Affiliation : * Department of Medicine, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
Background : Right ventricular dysfunction (RVD) is common in critically ill patients and the presence of this condition affects
patients’ outcomes. Improving the knowledge background and establishing the incidence of RVD in septic shock patients
would render the management more efficacious. This study was performed to evaluate the incidence and outcomes of RVD in
septic shock patients.
Material and Method: A single center, retrospective observational study was performed in the Medical ICU, Siriraj Hospital,
Mahidol University between January 2007 and October 2009. Patients with septic shock in whom pulmonary artery catheter
(PAC) was inserted were included in the study.
Results : The PAC was placed in 118 patients during the study period. The patients’ mean age was 58.0 + 18.5 years and 71
of them (59.3%) were male. The mean body mass index was 25.0 + 6.6 Kg/m2 and the mean APACHE II score was 26.1 + 7.7.
The admission diagnoses were severe sepsis or septic shock (70%), severe pneumonia (38%), acute respiratory distress
syndrome (21%). Twenty one patients (17.8%) meet the diagnosis criteria of RVD. The hospital mortality in RVD patients
tended to be higher than the non-RVD patients (81.0% vs. 60.8%, p 0.06). Although similar proportions of both group
received ventilatory support, the RVD patients had lower tidal volume and had higher peak airway pressure. Also the RVD
group had lower PaO2/FiO2 ratio. In addition, the RVD group had lower cardiac output and more frequently underwent renal
replacement therapy.
Conclusion : In patients with septic shock, the incidence of RVD is substantial. The significant factors associated with RVD
include low tidal volume and high peak airway pressure. Measures to prevent the alteration in lung compliance in septic
shock patients may prevent RVD and improve patients’ outcomes.
Keywords : Septic shock, Right ventricular dysfunction, Right ventricle, Pulmonary artery catheter
