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Bench-to-bedside review: Ventilatory abnormalities in sepsis

Sheldon Magder

Author Affiliations

McGill University Health Centre, Division of Critical Care, Department of Medicine, Pine Avenue W, Montreal, Quebec, H3A 1A1, Canada

Critical Care 2009, 13:202 doi:10.1186/cc7116

Published: 15 January 2009

Abstract

In septic patients increased central drive and increased metabolic demands combine to increase energy demands on the ventilatory muscles. This occurs at a time when energy supplies are limited and energy production hindered, and it leads to an energy supply-demand imbalance and often ventilatory failure. Problems related to contractile function of the ventilatory muscles also contribute, especially when the clinical course is prolonged. The increased ventilatory activity increases interactions between the ventilatory and cardiovascular systems, and when ventilatory muscles fail and mechanical ventilatory support is required a new set of problems emerges. In this review I discuss factors related to ventilatory muscle failure, giving emphasis to mechanical and supply demand aspects. I also review the implications of changes in ventilatory patterns for heart-lung interactions.