Right ventricular dysfunction in septic shock: assessment by measurements of right ventricular ejection fraction using the thermodilution technique

Right ventricular ejection fraction (RVEF) was measured by the thermodilution technique in a scries of 127 consecutive critically ill patients monitored with a modified pulmonary artery (PA) catheter equipped with a fast response thermistor. Thermodilution RVEF was significantly lower in septic shock (23.8 8.2%, 93 measurements) than in sepsis without shock (30.3 10.1%, 118 measurements) or in the absence of sepsis or cardiopulmonary impairment (32.5 7.1%, 62 measurements). Both myocardial depression and pulmonary hypertension could account for this impairment of RV function. RVEF decreased from 35.1 9.8 to 24.2 10.4% ( P < 0.01) during development of septic shock and increased from 25.0 7.6 to 29.8 8.5%, ( P < 0.05) during recovery (14 patients). Initial RVEF in septic shock was 27.8 8.6% in 11 patients who survived but only 20.9 6.7% ( P < 0.02) in the 23 patients who eventually died. Thus, RV dysfunction is common during septic shock, is directly related to its severity, and can easily be recognized in patients monitored with a PA catheter.