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Left ventricular failure with sepsis — Clinical Guidelines

Overview

Left ventricular failure in the context of sepsis refers to impaired cardiac function, specifically the heart's ability to pump blood effectively, occurring as a complication of severe infection and systemic inflammation. This can manifest as reduced cardiac output and inadequate tissue perfusion.

Diagnosis

Management

Ultra-short-acting beta-blockers (esmolol or landiolol) did not significantly improve mortality in patients with sepsis and persistent tachycardia 1.

Adjunctive vasopressors added to norepinephrine may reduce short-term mortality in adults with septic shock (low certainty evidence) 2.

Each hour of delay in antibiotic administration after the first hour increases in-hospital mortality in patients with sepsis or septic shock 3.

Early versus late norepinephrine administration showed no significant difference in overall mortality in septic shock patients in RCTs, but may be beneficial in specific scenarios without restrictive fluid strategies 4.

Restrictive fluid resuscitation did not significantly reduce mortality in patients with sepsis compared to usual care 5.

Limited fluid resuscitation may be beneficial for septic shock patients, reducing mortality, multiple organ dysfunction syndrome, ARDS, and DIC 7.

Special Populations

Key Recommendations

Administer antibiotics as soon as possible in patients with sepsis or septic shock, as each hour of delay after the first hour increases in-hospital mortality 3. (Evidence: Moderate)

Consider adjunctive vasopressors in adults with septic shock, as they may reduce short-term mortality 2. (Evidence: Weak)

Limited fluid resuscitation may be beneficial in septic shock patients, potentially reducing mortality and organ dysfunction 7. (Evidence: Moderate)

Ultra-short-acting beta-blockers (esmolol or landiolol) are not recommended to improve mortality in patients with sepsis and persistent tachycardia 1. (Evidence: Moderate)

References

1 Sato R, Messina S, Hasegawa D, Santonocito C, Scimonello G, Sanfilippo G et al.. Mortality in Patients With Sepsis Treated With Esmolol or Landiolol: A Systematic Review and Meta-Analysis of Randomized Controlled Trials With Trial Sequential Analysis. Chest 2025. link 2 Bauer SR, Wieruszewski PM, Bissell Turpin BD, Dugar S, Sacha GL, Sato R et al.. ADJUNCTIVE VASOPRESSORS AND SHORT-TERM MORTALITY IN ADULTS WITH SEPTIC SHOCK: A SYSTEMATIC REVIEW AND META-ANALYSIS. Shock (Augusta, Ga.) 2025. link 3 Tang F, Yuan H, Li X, Qiao L. Effect of delayed antibiotic use on mortality outcomes in patients with sepsis or septic shock: A systematic review and meta-analysis. International immunopharmacology 2024. link 4 Ahn C, Yu G, Shin TG, Cho Y, Park S, Suh GY. Comparison of Early and Late Norepinephrine Administration in Patients With Septic Shock: A Systematic Review and Meta-Analysis. Chest 2024. link 5 Reynolds PM, Stefanos S, MacLaren R. Restrictive resuscitation in patients with sepsis and mortality: A systematic review and meta-analysis with trial sequential analysis. Pharmacotherapy 2023. link 6 Liu YC, Yao Y, Yu MM, Gao YL, Qi AL, Jiang TY et al.. Frequency and mortality of sepsis and septic shock in China: a systematic review and meta-analysis. BMC infectious diseases 2022. link 7 Jiang S, Wu M, Lu X, Zhong Y, Kang X, Song Y et al.. Is restrictive fluid resuscitation beneficial not only for hemorrhagic shock but also for septic shock?: A meta-analysis. Medicine 2021. link

Left ventricular failure with sepsis