Cardiovascular Monitoring in Severe Sepsis or Septic Shock

Abstract

The American College of Chest Physicians & Society of Critical Care Medicine Consensus [1] defines sepsis as the systemic inflammatory response syndrome (SIRS) as a result of infection. Septic shock is defined as sepsis-induced hypotension despite adequate fluid resuscitation along with the presence of perfusion abnormalities. These abnormalities may include, but are not limited to, lactic acidosis, oliguria or an acute alteration in mental status. Patients who are receiving inotropic or vasopressor agents may not be hypotensive at the time that perfusion abnormalities are measured. During the years 1950–1991 mortality soared 13-fold [2]. Alone sepsis carries a 30–40% lethality [2], but when aggravated by shock it has a 40–60% mortality [3]. Recently the effectiveness of invasive hemodynamic monitoring in septic shock has undergone intense scrutiny. A lack of well designed prospective studies assessing this problem has cast a shadow of doubt over the lowering of morbidity or mortality (attributable to the right heart catheterization). A moratorium on their placement was suggested in the literature, which prompted a consensus conference in 1997 to help clarify the role of the pulmonary artery catheter in the critically ill [4].