Right Ventricular Dysfunction in Sepsis: Now You See It, Now You Don’t

Current Surviving Sepsis Campaign guidelines inadequately address the limitations of central venous pressure monitoring, which are due, in part, to right and left ventricular dysfunction associated with sepsis. Septic cardiomyopathy is well described in the literature but is both underrecognized and undertreated clinically. Direct cardiac assessment with transesophageal echocardiography (TEE) has documented advantages, but is limited by single evaluations and the need for advanced training. Recently, a disposable, monoplane TEE probe that provides for serial echocardiographic assessments in unstable patients to guide medical management, or hemodynamic TEE (hTEE), has been introduced. This article reviews a case of a 48-year-old gentleman with a history of smoking, chronic obstructive pulmonary disease, and Child’s A cirrhosis who underwent an uneventful off-pump coronary artery bypass grafting and 2 days later developed septic shock from pneumonia complicated by right ventricular dysfunction. hTEE provided a rational guide to fluid resuscitation, vasopressor, and inotropic therapy with ensuing patient convalescence. Although there is a lack of hTEE experience among current intensivists, there is a desire to learn echocardiography as witnessed by the success of echocardiography courses and interest among critical care fellows. Future work to assess echocardiographic hemodynamic protocols and their effect on outcomes will be important.