Sepsis-induced cardiogenic shock: controversies and evidence gaps in diagnosis and management
Abstract Sepsis often leads to vasoplegia and a hyperdynamic cardiac state, with treatment focused on restoring vascular tone. However, sepsis can also cause reversible myocardial dysfunction, particularly in the elderly with pre-existing heart conditions. The Surviving Sepsis Campaign Guidelines re...
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2025-01-01
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| Online Access: | https://doi.org/10.1186/s40560-024-00770-y |
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| author | Ryota Sato Daisuke Hasegawa Stephanie Guo Abdulelah E. Nuqali Jesus E. Pino Moreno |
| author_facet | Ryota Sato Daisuke Hasegawa Stephanie Guo Abdulelah E. Nuqali Jesus E. Pino Moreno |
| author_sort | Ryota Sato |
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| description | Abstract Sepsis often leads to vasoplegia and a hyperdynamic cardiac state, with treatment focused on restoring vascular tone. However, sepsis can also cause reversible myocardial dysfunction, particularly in the elderly with pre-existing heart conditions. The Surviving Sepsis Campaign Guidelines recommend using dobutamine with norepinephrine or epinephrine alone for patients with septic shock with cardiac dysfunction and persistent hypoperfusion despite adequate fluid resuscitation and stable blood pressure. However, the definition of cardiac dysfunction and hypoperfusion in these guidelines remains controversial, leading to varied clinical interpretations. Cardiac dysfunction with persistent hypoperfusion despite restoring adequate preload and afterload is often considered a cardiogenic shock. Therefore, sepsis complicated by new-onset myocardial dysfunction or worsening of underlying myocardial dysfunction due to sepsis-induced cardiomyopathy, resulting in cardiogenic shock, can be defined as “Sepsis-induced cardiogenic shock (SICS)”. SICS is known to be associated with significantly higher mortality. A history of cardiac dysfunction is a strong predictor of SICS, highlighting the need for precise diagnosis and management given the aging population and rising cardiovascular disease prevalence. Therefore, SICS might benefit from early invasive hemodynamic monitoring with a pulmonary artery catheter (PAC), unlike those with septic shock alone. While routine PAC monitoring for all septic patients is impractical, echocardiography could be a useful screening tool for high-risk individuals. If echocardiography indicates cardiogenic shock, PAC might be warranted for continuous monitoring. The role of inotropes in SICS remains uncertain. Mechanical circulatory support (MCS) might be considered for severe cases, as high-dose vasopressors and inotropes are associated with worse outcomes. Correct patient selection is the key to improving outcomes with MCS. Engaging a cardiogenic shock team for a multidisciplinary approach can be beneficial. In summary, addressing the evidence gaps in SICS diagnosis and management is crucial. Echocardiography for screening, advanced monitoring with PAC, and careful patient selection for MCS are important for optimal patient care. |
| format | Article |
| id | doaj-art-8f1ebd57d20645e882bccd46f098d273 |
| institution | Kabale University |
| issn | 2052-0492 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | BMC |
| record_format | Article |
| series | Journal of Intensive Care |
| spelling | doaj-art-8f1ebd57d20645e882bccd46f098d2732025-01-05T12:09:57ZengBMCJournal of Intensive Care2052-04922025-01-0113111010.1186/s40560-024-00770-ySepsis-induced cardiogenic shock: controversies and evidence gaps in diagnosis and managementRyota Sato0Daisuke Hasegawa1Stephanie Guo2Abdulelah E. Nuqali3Jesus E. Pino Moreno4Division of Critical Care Medicine, Department of Medicine, The Queen’s Medical CenterDivision of Pulmonary, Allergy, and Critical Care, Perelman School of Medicine at the University of PennsylvaniaDivision of Pulmonary and Critical Care Medicine, Department of Medicine, The Queen’s Medical CenterDepartment of Medicine, John A. Burns School of Medicine, University of Hawai’iDepartment of Medicine, John A. Burns School of Medicine, University of Hawai’iAbstract Sepsis often leads to vasoplegia and a hyperdynamic cardiac state, with treatment focused on restoring vascular tone. However, sepsis can also cause reversible myocardial dysfunction, particularly in the elderly with pre-existing heart conditions. The Surviving Sepsis Campaign Guidelines recommend using dobutamine with norepinephrine or epinephrine alone for patients with septic shock with cardiac dysfunction and persistent hypoperfusion despite adequate fluid resuscitation and stable blood pressure. However, the definition of cardiac dysfunction and hypoperfusion in these guidelines remains controversial, leading to varied clinical interpretations. Cardiac dysfunction with persistent hypoperfusion despite restoring adequate preload and afterload is often considered a cardiogenic shock. Therefore, sepsis complicated by new-onset myocardial dysfunction or worsening of underlying myocardial dysfunction due to sepsis-induced cardiomyopathy, resulting in cardiogenic shock, can be defined as “Sepsis-induced cardiogenic shock (SICS)”. SICS is known to be associated with significantly higher mortality. A history of cardiac dysfunction is a strong predictor of SICS, highlighting the need for precise diagnosis and management given the aging population and rising cardiovascular disease prevalence. Therefore, SICS might benefit from early invasive hemodynamic monitoring with a pulmonary artery catheter (PAC), unlike those with septic shock alone. While routine PAC monitoring for all septic patients is impractical, echocardiography could be a useful screening tool for high-risk individuals. If echocardiography indicates cardiogenic shock, PAC might be warranted for continuous monitoring. The role of inotropes in SICS remains uncertain. Mechanical circulatory support (MCS) might be considered for severe cases, as high-dose vasopressors and inotropes are associated with worse outcomes. Correct patient selection is the key to improving outcomes with MCS. Engaging a cardiogenic shock team for a multidisciplinary approach can be beneficial. In summary, addressing the evidence gaps in SICS diagnosis and management is crucial. Echocardiography for screening, advanced monitoring with PAC, and careful patient selection for MCS are important for optimal patient care.https://doi.org/10.1186/s40560-024-00770-ySeptic shockCardiogenic shockSepsis-induced cardiomyopathySeptic cardiomyopathyMixed shockMechanical circulatory support |
| spellingShingle | Ryota Sato Daisuke Hasegawa Stephanie Guo Abdulelah E. Nuqali Jesus E. Pino Moreno Sepsis-induced cardiogenic shock: controversies and evidence gaps in diagnosis and management Journal of Intensive Care Septic shock Cardiogenic shock Sepsis-induced cardiomyopathy Septic cardiomyopathy Mixed shock Mechanical circulatory support |
| title | Sepsis-induced cardiogenic shock: controversies and evidence gaps in diagnosis and management |
| title_full | Sepsis-induced cardiogenic shock: controversies and evidence gaps in diagnosis and management |
| title_fullStr | Sepsis-induced cardiogenic shock: controversies and evidence gaps in diagnosis and management |
| title_full_unstemmed | Sepsis-induced cardiogenic shock: controversies and evidence gaps in diagnosis and management |
| title_short | Sepsis-induced cardiogenic shock: controversies and evidence gaps in diagnosis and management |
| title_sort | sepsis induced cardiogenic shock controversies and evidence gaps in diagnosis and management |
| topic | Septic shock Cardiogenic shock Sepsis-induced cardiomyopathy Septic cardiomyopathy Mixed shock Mechanical circulatory support |
| url | https://doi.org/10.1186/s40560-024-00770-y |
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