Vasodilator therapy in clinical sepsis with low output syndrome

Eight patients presented with gram-negative speticemia and septic shock. After appropriate medical and surgical therapy, they underwent a transition from a high cardiac output, low TPR state into a low cardiac, high TPR state with a significant fall in oxygen consumption. This state was refractory to maximized volume expansion and inotropic support. Vasodilator therapy with nitroglycerine paste was initiated along with intense, longitudinal physiologic assessment. All patients had a significant fall in TPR, rise in cardiac output, improvement in contractility, and increase in oxygen consumption. Five of the eight patients survived. Vasodilator therapy with nitroglycerine paste is an effective mode of treating the often catastrophic complication of myocardial decompensation in gram-negative septic shock.