Clinical and Laboratory Parameters Associated with Septic Myocardial Dysfunction in Children with Septic Shock

The pathophysiology of sepsis and septic shock involves complex cytokine and inflammatory mediator networks. NF-κB activation is a central event leading to the activation of these networks. The role of NF-κB in septic pathophysiology and the signal transduction pathways leading to NF-κB activation during sepsis have been an area of intensive investigation. NF-κB is activated by a variety of pathogens known to cause septic shock syndrome. NF-κB activity is markedly increased in every organ studied, both in animal models of septic shock and in human subjects with sepsis. Greater levels of NF-κB activity are associated with a higher rate of mortality and worse clinical outcome. NF-κB mediates the transcription of exceptional large number of genes, the products of which are known to play important roles in septic pathophysiology. Mice deficient in those NF-κB-dependent genes are resistant to the development of septic shock and to septic lethality. More importantly, blockade of NF-κB pathway corrects septic abnormalities. Inhibition of NF-κB activation restores systemic hypotension, ameliorates septic myocardial dysfunction and vascular derangement, inhibits multiple proinflammatory gene expression, diminishes intravascular coagulation, reduces tissue neutrophil influx, and prevents microvascular endothelial leakage. Inhibition of NF-κB activation prevents multiple organ injury and improves survival in rodent models of septic shock. Thus NF-κB activation plays a central role in the pathophysiology of septic shock.

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Clinical Spectrum, Frequency, and Significance of Myocardial Dysfunction in Severe Sepsis and Septic Shock

Mayo Clinic Proceedings ◽

10.1016/j.mayocp.2012.01.018 ◽

2012 ◽

Vol 87 (7) ◽

pp. 620-628 ◽

Cited By ~ 139

Author(s):

Juan N. Pulido ◽

Bekele Afessa ◽

Mitsuru Masaki ◽

Toshinori Yuasa ◽

Shane Gillespie ◽

...

Keyword(s):

Septic Shock ◽

Severe Sepsis ◽

Myocardial Dysfunction ◽

Clinical Spectrum ◽

Sepsis And Septic Shock

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1362: LONG-TERM NEW-ONSET HEART FAILURE IN PATIENTS WITH MYOCARDIAL DYSFUNCTION IN SEPSIS AND SEPTIC SHOCK

Critical Care Medicine ◽

10.1097/01.ccm.0000510036.21963.c3 ◽

2016 ◽

Vol 44 (12) ◽

pp. 416-416

Author(s):

Saraschandra Vallabhajosyula ◽

Jacob Jentzer ◽

Jeffrey Geske ◽

Kianoush Kashani ◽

Ognjen Gajic ◽

...

Keyword(s):

Heart Failure ◽

Septic Shock ◽

Myocardial Dysfunction ◽

Sepsis And Septic Shock ◽

New Onset

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Sequential Extracorporeal Therapy Collaborative Device and Timely Support for Endotoxic, Septic, and Cardiac Shock: A Case Report

Blood Purification ◽

10.1159/000505146 ◽

2019 ◽

Vol 49 (4) ◽

pp. 502-508 ◽

Cited By ~ 3

Author(s):

Silvia De Rosa ◽

Sara Samoni ◽

Claudio Ronco

Keyword(s):

Septic Shock ◽

Myocardial Dysfunction ◽

Endotoxic Shock ◽

Left Ventricular ◽

Left Ventricular Ejection ◽

Septic Cardiomyopathy ◽

Ventricular Ejection Fraction ◽

Circulatory Insufficiency ◽

Extracorporeal Therapy ◽

Va Ecmo

We report a 49-year-old man, without prior medical history, consulted in the emergency department with a 5 day history of cough, fever, and dysuria. He was admitted to the intensive care unit due to septic shock. Critical care management was initiated, including mechanical ventilation and vasopressors. Endotoxic shock was suspected (endotoxin activity assay [EAA] 0.75), and 2 treatments with Polymyxin B hemoperfusion (Toraymyxin®, Toray Medical Co., Ltd., Tokyo, Japan) were performed in 48 h, alternate with high-volume hemofiltration sessions. Initial blood cultures were positive for Neisseria meningitidis (serogroup B), and a lumbar puncture was deferred because of the coagulopathy and a bleeding risk. The circulatory efficiency significantly improved after the second procedure of hemoperfusion, and the treatment resulted in a marked decrease in the serum endotoxin level (EAA <0.4). However, after 48 h, tachycardia did not improve, left ventricular ejection fraction was 20%, and circulatory insufficiency progressed. Therefore, considering the involvement of septic cardiomyopathy and cardiogenic shock, veno-arterial extracorporeal membrane oxygenation (VA-ECMO) was initiated for circulation assistance on day 3 from admission. Continuous cytokine hemoadsorption (Cytosorb®, Cytosorbent Corporation, Monmouth Junction, NJ, USA) was incorporated into a VA-ECMO circuit for 48 h without a considerable improvement. For this reason, a 72-h continuous veno-venous hemodialysis session was started in which a high cutoff filter was used. Tachycardia and myocardial dysfunction improved by day 6, and VA-ECMO was withdrawn on the tenth day. Subsequently, nutrition management and rehabilitation were performed, and the patient was transferred to the department of respiratory medicine on day 80, he was discharged from our hospital on day 113. Sequential extracorporeal therapy may be beneficial when concomitant with circulatory assistance in uncontrollable cases of septic shock using catecholamines and blockers.

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Role of interleukin 6 in myocardial dysfunction of meningococcal septic shock

The Lancet ◽

10.1016/s0140-6736(03)15326-3 ◽

2004 ◽

Vol 363 (9404) ◽

pp. 203-209 ◽

Cited By ~ 194

Author(s):

Nazima Pathan ◽

Cheryl A Hemingway ◽

Ash A Alizadeh ◽

Alick C Stephens ◽

Jennifer C Boldrick ◽

...

Keyword(s):

Septic Shock ◽

Interleukin 6 ◽

Myocardial Dysfunction ◽

Meningococcal Septic Shock

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Characterization of Myocardial Dysfunction in Fluid- and Catecholamine-Refractory Pediatric Septic Shock and Its Clinical Significance

Journal of Intensive Care Medicine ◽

10.1177/0885066616685247 ◽

2016 ◽

Vol 34 (1) ◽

pp. 17-25 ◽

Cited By ~ 6

Author(s):

Feifei Z. Williams ◽

Ritu Sachdeva ◽

Curtis D. Travers ◽

Karen H. Walson ◽

Kiran B. Hebbar

Keyword(s):

Septic Shock ◽

Intensive Care ◽

Clinical Significance ◽

Cold Shock ◽

Myocardial Dysfunction ◽

Systolic Dysfunction ◽

Severity Of Illness ◽

Left Ventricular ◽

Hospital Length Of Stay ◽

Z Score

Purpose: Myocardial dysfunction is a known complication in patients with pediatric septic shock (PSS); however, its clinical significance remains unclear. The purpose of this study was to characterize left ventricular (LV) and right ventricular (RV) dysfunction and their prevalence in patients with PSS using echocardiography (echo) and to investigate their associations with the severity of illness and clinical outcomes. Methods: Retrospective chart review between 2010 and 2015 from 2 tertiary care pediatric intensive care units. Study included 78 patients (mean age 9.3 ± 7 years) from birth up to 21 years who fulfilled criteria for fluid- and catecholamine-refractory septic shock. Echocardiographic parameters of systolic, diastolic, and global function were measured offline. They were correlated with admission Pediatric Risk of Mortality III (PRISM III) and Pediatric Logistic Organ Dysfunction scores, vasoactive–inotrope score (VIS), β-type natriuretic peptide (BNP), lactate, type of shock, duration of mechanical ventilation (MV), intensive care unit and hospital length of stay, and mortality. Results: Overall, 28-day mortality was 26%, and 88% patients required MV. Prevalence of LV dysfunction was 72% and RV dysfunction was 63%. LV systolic dysfunction (fractional shortening z score <−2) was significantly associated with PRISM III, VIS, and BNP. RV systolic dysfunction (tricuspid annular plane systolic excursion z score <−2) was significantly associated with cold shock. LV and RV diastolic dysfunction did not have any significant clinical associations. No echocardiographic measures were associated with mortality. Conclusion: Myocardial dysfunction is highly prevalent in PSS but is not associated with mortality. LV systolic dysfunction is associated with a higher severity of illness, use of vasoactives, and BNP, whereas RV systolic dysfunction is associated with cold shock. Further studies are needed to determine the utility of echo in the bedside management of patients with PSS.

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