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Septic Cardiomyopathy

Beesley, Sarah J., MD1,2; Weber, Gerhard, MD, PhD3; Sarge, Todd, MD4; Nikravan, Sara, MD5; Grissom, Colin K., MD, FASE, FCCM1,2; Lanspa, Michael J., MD, MS, FASE, FCCM1; Shahul, Sajid, MD, MPH6; Brown, Samuel M., MD, MS, FCCM, FASE1,2

doi: 10.1097/CCM.0000000000002851
Concise Definitive Review

Objectives: To describe, with an emphasis on clinical applications, what is known about the pathophysiology, management, and implications of septic cardiomyopathy in the adult ICU.

Data Sources and Study Selection: A PubMed literature review was performed for relevant articles. Only articles in English that studied human adults with sepsis were included.

Data Extraction and Data Synthesis: Multiple competing definitions for septic cardiomyopathy hinder understanding of this entity. Although many patients with sepsis develop cardiac dysfunction, the impact of septic cardiomyopathy on prognosis and therapy remains to be demonstrated. Treatment of septic cardiomyopathy is aimed at treating the underlying sepsis and providing specific supportive care for cardiogenic shock when present.

Conclusions: Septic cardiomyopathy is an important contributor to organ dysfunction in sepsis. Guided treatment of septic cardiomyopathy may affect patients’ prognosis, especially when their cardiac index is substantially decreased. The implication of septic cardiomyopathy for both short- and long-term outcomes is an important area for future investigation.

1Pulmonary Division, Department of Medicine, Intermountain Medical Center, Murray, UT.

2Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Utah School of Medicine, Salt Lake City, UT.

3Division of Cardiovascular Medicine, Stanford University, Stanford, CA.

4Department of Anesthesia, Beth Israel Deaconess Medical Center, Boston, MA.

5Department of Anesthesia, Stanford University, Stanford, CA.

6Department of Anesthesia, University of Chicago, Chicago, IL.

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Dr. Sarge’s institution received funding from the National Institutes of Health/National Heart, Lung, and Blood (UM1 NIH/NHLBI) as the site principal investigator for EPVent2: A Phase II study of Mechanical Ventilation Directed by Transpulmonary Pressures, and he received funding from Christie & Young P.C. (legal consulting) and the Society of Critical Care Medicine (SCCM) (speaking honoraria and travel expenses). Dr. Grissom received funding for teaching critical care ultrasound from SCCM (honorarium and travel expenses), the American Thoracic Society (honorarium), and the Beth Israel Deaconess Medical Center (honorarium and travel expenses). The remaining authors have disclosed that they do not have any potential conflicts of interest.

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