Septic cardiomyopathy is frequently observed in patients with severe sepsis
however it often does not require specific therapy. In patients presenting signs of tissue
perfusion and inadequate cardiac output, manipulation of cardiac output should be
considered. The first line therapies consist in optimization of preload by fluid
administration and of afterload by decreasing the doses of vasopressor agents whenever
possible. Inotropic agents should then be considered. Among these dobutamine remains
the most commonly used, even though there is a huge individual variability in the
response to it. The lowest dose associated with a satisfactory hemodynamic state
should be used, as high doses for a prolonged period of time can be associated with
impaired outcome. Phosphodiesterase inhibitors are often limited by their peripheral
dilatory properties. Levosimendan is a promising inotropic agent, but its superiority to
classical adrenergic inotropic agents remains to be determined.
Keywords: Adrenergic agents, Cardiac function, Cardiac output, Circulatory failure,
ECMO, Inotropic agents, Levosimendan, Phosphodiesterase inhibitors, Tissue perfusion.
