Therapeutic Dilemmas in Mixed Septic-Cardiogenic Shock

Sepsis is an increasing cause of decompensation in patients with chronic heart failure with reduced or preserved ejection fraction. Sepsis and decompensated heart failure results in a mixed septic-cardiogenic shock that poses several therapeutic dilemmas: Rapid fluid resuscitation is the cornerstone of sepsis management, while loop diuretics are the main stay of decompensated heart failure treatment. Whether inotropic therapy with dobutamine or inodilators improves microvascular alterations remains unsettled in sepsis. When to resume loop diuretic therapy in patients with sepsis and decompensated heart failure is unclear. In the absence of relevant guidelines, we review vasopressor therapy, the timing and volume of fluid resuscitation, and the need for inotropic therapy in patients who, with sepsis and decompensated heart failure, present with a mixed septic-cardiogenic shock.

Automated summary

Sepsis is a growing cause of decompensation in chronic heart failure patients, regardless of whether their ejection fraction is reduced or preserved. The combination of sepsis and decompensated heart failure leads to a mixed septic-cardiogenic shock, creating therapeutic dilemmas. Rapid fluid resuscitation is crucial for managing sepsis, while loop diuretics are the main treatment for decompensated heart failure. The effectiveness of inotropic therapy with dobutamine or inodilators in improving microvascular alterations in sepsis remains unclear. The timing for reintroducing loop diuretics in sepsis patients with decompensated heart failure is also uncertain. Due to the lack of guidelines, this review focuses on vasopressor therapy, the timing and volume of fluid resuscitation, and the need for inotropic therapy in patients presenting with a mixed septic-cardiogenic shock.