THE EFFECTS OF BACTERIAL SEPSIS ON MYOCARDIAL FUNCTION

Abstract

We studied the effects of serum from children with bacterial sepsis and poor cardiac function on isolated myocardial muscle performance. We measured the force (F_max -mg) and dF/dt (gm/sec) of isolated dog papillary muscle contraction. Control serum was obtained from 3 uninfected subjects and a normotensive child with S. aureus bacteremia. Our 4 study subjects had hypotension and bacteremia due to either H. influenza, N. meningitidis, Yersinia pestis or D. pneumoniae. All study subjects required mechanical ventilation and inotropic support - mean LV % fractional shortening = 21%(nl=28-40%), mean Doppler cardiac output = 3.2 L/min/M² (nl=2.5-4.5) and mean systemic vascular resistance = 11.6 units (nl=18-28). Baseline F_max and dF/dt were compared to values measured 10 minutes after the addition of 0.3-1.0 ml of serum to the 50ml muscle bath.

Serum from study subjects caused significant reductions in F_max and dF/dt. We conclude that children with bacteremia and depressed myocardial function have a serum myocardial depressant factor which may also reduce vascular tone. Definition of this factor may provide new directions for the early management of hemodynamic distress in these critically ill subjects.

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