<abstract xmlns="http://www.w3.org/1999/xhtml"><sec id="j_jccm-2019-0022_s_005_w2aab3b7b4b1b6b1aab1c18b1Aa"><h3>Background</h3><p>The systemic inflammatory response syndrome (SIRS) is a complex immune response which can be precipitated by non-infectious aetiologies such as trauma, burns or pancreatitis. Addressing the underlying cause is crucial because it can be associated with increased mortality. Although the current literature associates chronic heart failure with SIRS, acute right ventricular dysfunction has not previously been reported to trigger SIRS. This case report describes the presentation of acute right ventricular dysfunction that triggered SIRS and mimicked septic shock.</p></sec><sec id="j_jccm-2019-0022_s_006_w2aab3b7b4b1b6b1aab1c18b2Aa"><h3>Case presentation</h3><p>A 70-year-old male presented to the Intensive Care Unit (ICU) with elevated inflammatory markers and refractory hypotension after a robotic-assisted laparoscopic radical choledochectomy with pancreaticoduodenectomy. Septic shock was misdiagnosed, and he was later found to have a pulmonary embolus. Thrombectomy and antimicrobials had no significant efect on lowering the elevated inflammatory markers or improving the persistent hypotension. Through Point of Care Ultrasound (POCUS), right ventricular dysfunction was diagnosed. Treatment with intravenous milrinone improved blood pressure, normalised inflammatory markers and led to a prompt discharge from the ICU.</p></sec><sec id="j_jccm-2019-0022_s_007_w2aab3b7b4b1b6b1aab1c18b3Aa"><h3>Conclusion</h3><p>Acute right ventricular dysfunction can trigger SIRS, which may mimic septic shock and delay appropriate treatment.</p></sec></abstract>

BackgroundThe systemic inflammatory response syndrome (SIRS) is a complex immune response which can be precipitated by non-infectious aetiologies such as trauma, burns or pancreatitis. Addressing the underlying cause is crucial because it can be associated with increased mortality. Although the current literature associates chronic heart failure with SIRS, acute right ventricular dysfunction has not previously been reported to trigger SIRS. This case report describes the presentation of acute right ventricular dysfunction that triggered SIRS and mimicked septic shock.Case presentationA 70-year-old male presented to the Intensive Care Unit (ICU) with elevated inflammatory markers and refractory hypotension after a robotic-assisted laparoscopic radical choledochectomy with pancreaticoduodenectomy. Septic shock was misdiagnosed, and he was later found to have a pulmonary embolus. Thrombectomy and antimicrobials had no significant efect on lowering the elevated inflammatory markers or improving the persistent hypotension. Through Point of Care Ultrasound (POCUS), right ventricular dysfunction was diagnosed. Treatment with intravenous milrinone improved blood pressure, normalised inflammatory markers and led to a prompt discharge from the ICU.ConclusionAcute right ventricular dysfunction can trigger SIRS, which may mimic septic shock and delay appropriate treatment.

SIRS Triggered by Acute Right Ventricular Function, Mimicked Septic Shock

The Journal of Critical Care Medicine

This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 License.

{"article-title":"SIRS Triggered by Acute Right Ventricular Function, Mimicked Septic Shock"}

BackgroundThe systemic inflammatory response syndrome (SIRS) is a complex immune response which can be precipitated by non-infectious aetiologies such as...

SIRS Triggered by Acute Right Ventricular Function, Mimicked Septic Shock

Article Category: Case report

Published Online: Nov 27, 2019

Page range: 149 - 156

Received: May 31, 2019

Accepted: Sep 23, 2019

DOI: https://doi.org/10.2478/jccm-2019-0022

Keywords
Point of Care Ultrasound (POCUS), acute right ventricular failure, acute right ventricular dysfunction, systemic inflammatory response syndrome, septic shock, sepsis

© 2019 Yingke He, John Ong, Thuan Tong Tan, Brian K. P. Goh, Sharon G. K. Ong, published by Sciendo

This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 License.

SIRS Triggered by Acute Right Ventricular Function, Mimicked Septic Shock

Article Category: Case report

Published Online: Nov 27, 2019

Page range: 149 - 156

Received: May 31, 2019

Accepted: Sep 23, 2019

DOI: https://doi.org/10.2478/jccm-2019-0022

KeywordsPoint of Care Ultrasound (POCUS), acute right ventricular failure, acute right ventricular dysfunction, systemic inflammatory response syndrome, septic shock, sepsis

© 2019 Yingke He, John Ong, Thuan Tong Tan, Brian K. P. Goh, Sharon G. K. Ong, published by Sciendo

This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 License.

Keywords
Point of Care Ultrasound (POCUS), acute right ventricular failure, acute right ventricular dysfunction, systemic inflammatory response syndrome, septic shock, sepsis