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2016 ; 4
(ä): 22
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Sepsis-induced myocardial dysfunction: pathophysiology and management
#MMPMID27011791
Kakihana Y
; Ito T
; Nakahara M
; Yamaguchi K
; Yasuda T
J Intensive Care
2016[]; 4
(ä): 22
PMID27011791
show ga
Sepsis is aggravated by an inappropriate immune response to invading
microorganisms, which occasionally leads to multiple organ failure. Several lines
of evidence suggest that the ventricular myocardium is depressed during sepsis
with features of diastolic dysfunction. Potential candidates responsible for
septic cardiomyopathy include pathogen-associated molecular patterns (PAMPs),
cytokines, and nitric oxide. Extracellular histones and high-mobility group box 1
that function as endogenous damage-associated molecular patterns (DAMPs) also
contribute to the myocardial dysfunction associated with sepsis. If untreated,
persistent shock causes cellular injury and the liberation of further DAMPs. Like
PAMPs, DAMPs have the potential to activate inflammation, creating a vicious
circle. Early infection control with adequate antibiotic care is important during
septic shock to decrease PAMPs arising from invasive microorganisms. Early
aggressive fluid resuscitation as well as the administration of vasopressors and
inotropes is also important to reduce DAMPs generated by damaged cells although
excessive volume loading, and prolonged administration of catecholamines might be
harmful. This review delineates some features of septic myocardial dysfunction,
assesses its most common underlying mechanisms, and briefly outlines current
therapeutic strategies and potential future approaches.