Hemodynamics determined by Swan-Ganz catheter in patients with septic shock

Detailed hemodynamic data were studied for seven patients with severe septic shock resulting from various etiologies. Each had received strong antibiotics and vasopressor agents. Their septic severity scores ranged from 41 to 75. A Swan-Ganz catheter was used to measure cardiac output with thermodilutional methods. Cardiac index, systemic and pulmonary vascular resistance and left and right ventricular stroke index were determined. Three patients, all with low cardiac indices and high systemic vascular resistance, expired without response to vigorous treatment with catecholamines. One patient who had a high cardiac index but very low systemic vascular resistance also expired, despite the use of strong vasopressor agents. Three patients survived; two had a good response to vasodilators for high pulmonary vascular resistance. Swan-Ganz catheterization is helpful in patients with complicated septic shock with poor response to primary treatment, especially if there is associated heart disease. Adequate treatment of septic shock depends on informed judgement based on detailed hemodynamic data.