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Annals of Internal Medicine Aug 1990Septic shock is the commonest cause of death in intensive care units. Although sepsis usually produces a low systemic vascular resistance and elevated cardiac output,... (Review)
Review
Septic shock is the commonest cause of death in intensive care units. Although sepsis usually produces a low systemic vascular resistance and elevated cardiac output, strong evidence (decreased ejection fraction and reduced response to fluid administration) suggests that the ventricular myocardium is depressed and the ventricle dilated. In survivors, these abnormalities are reversible. Failure to develop ventricular dilatation in nonsurvivors suggests that dilatation is a compensatory mechanism needed to maintain adequate cardiac output. With a canine model of septic shock that is very similar to human sepsis, myocardial depression was confirmed using load-independent measures of ventricular performance. Endotoxin administration to humans simulates the qualitative, cardiovascular abnormalities of sepsis. The pathogenesis of septic shock is extraordinarily complex. Diverse microorganisms can generate toxins, stimulating release of potent mediators that act on vasculature and myocardium. A circulating myocardial depressant substance has been closely associated with the myocardial depression of human septic shock. Therapy has emphasized early use of antibiotics, critical care monitoring, aggressive volume resuscitation, and, if shock continues, use of inotropic agents and vasopressors. Pharmacologic or immunologic antagonism of endotoxin or other mediators may prove to enhance survival in this highly lethal syndrome.
Topics: Animals; Cardiovascular System; Dogs; Endotoxins; Humans; Shock, Septic; United States
PubMed: 2197912
DOI: 10.7326/0003-4819-113-3-227 -
Der Internist Jul 2009Septic shock is not only a circulatory shock but is also a cardiac shock, the consequence of a potentially reversible heart impairment known as septic cardiomyopathy.... (Review)
Review
Septic shock is not only a circulatory shock but is also a cardiac shock, the consequence of a potentially reversible heart impairment known as septic cardiomyopathy. Disturbances of macrocirculation as well as microcirculation, an individually heterogeneous reduction of cardiac function, and an extensive impairment of demand-oriented regulation of heart function characterize the septic shock state. Bacterial toxins, inflammatory mediators, and a disseminated intravasal coagulopathy are responsible for these disturbances; for the impairment of cardiac regulation, the interaction of endotoxin with the cardiac pacemaker current I(f) also plays a role. Circulatory shock as well as septic cardiomyopathy should be quantified: The lowering of systemic vascular resistance characterizes the extent of circulatory shock, and the reduction of relative cardiac output in relation to afterload characterizes the extent of septic cardiomyopathy. The intensity of circulatory as well as of cardiac impairment correlates with an unfavorable prognosis. Treatment of septic circulatory shock and of septic cardiomyopathy is predominantly symptomatic; first causal approaches are under investigation.
Topics: Cardiomyopathies; Humans; Shock, Septic
PubMed: 19499195
DOI: 10.1007/s00108-008-2286-6 -
Presse Medicale (Paris, France : 1983) Apr 2016Early and adequate resuscitation of patients with acute circulatory failure is important to restore the balance between oxygen needs and delivery. Haemodynamic... (Review)
Review
Early and adequate resuscitation of patients with acute circulatory failure is important to restore the balance between oxygen needs and delivery. Haemodynamic management can globally be separated into three categories according to the VIP mnemonic - Ventilate, Infuse, Pump - which should be considered simultaneously in the patient with shock. Sufficient oxygen should be given early, and endotracheal intubation and mechanical ventilation performed without hesitation if there is any indication that oxygenation is inadequate. Fluids should be administered using the SOSD mnemonic - Salvage, Optimization, Stabilization, De-escalation. After initial liberal administration, ongoing requirements should be guided by repeated fluid challenges using a combination of balanced crystalloid solutions and colloid. Noradrenaline is the vasopressor of choice and should be started early. Dobutamine may be needed to improve myocardial contractility and cardiac output. Haemodynamic support should be personalized according to individual patient characteristics and global and regional parameters of haemodynamic and oxygenation status.
Topics: Fluid Therapy; Hemodynamics; Humans; Monitoring, Physiologic; Oxygen Inhalation Therapy; Shock, Septic
PubMed: 27079763
DOI: 10.1016/j.lpm.2016.03.005 -
BMJ (Clinical Research Ed.) Jun 1993There have been important advances in the resuscitation of patients in septic shock in recent years. Survival can be improved by earlier recognition and therefore... (Review)
Review
There have been important advances in the resuscitation of patients in septic shock in recent years. Survival can be improved by earlier recognition and therefore eradication of the sepsis combined with logical supportive measures. As with any acutely ill patient consultation with intensive care unit staff may be useful. Consultation with the intensive care unit does not necessarily imply the need for admission and mechanical ventilation; helpful advice may be forthcoming. Equally, referral to the intensive care unit does not mean an admission of failure but merely a recognition that additional skills and technical facilities are necessary for the patient's survival.
Topics: Critical Care; Hemodynamics; Humans; Oxygen; Oxygen Consumption; Respiration, Artificial; Shock, Septic
PubMed: 8324438
DOI: 10.1136/bmj.306.6893.1661 -
African Journal of Medicine and Medical... Dec 1993
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The Journal of Emergency Medicine 1986
Review
Topics: Aminoglycosides; Anti-Bacterial Agents; Humans; Naloxone; Shock, Septic; Steroids
PubMed: 3525661
DOI: 10.1016/0736-4679(86)90112-5 -
Indian Journal of Pediatrics 1993Septic shock is the host's inflammatory response to infection. There are multiple endogenous mediators responsible for the pathogenesis of septic shock. Cytokines,... (Review)
Review
Septic shock is the host's inflammatory response to infection. There are multiple endogenous mediators responsible for the pathogenesis of septic shock. Cytokines, nitric oxide and prostaglandins are some of the major mediators. The term sepsis syndrome allows for an earlier diagnosis and treatment. Management of septic shock is focused in maintaining hemodynamic stability and an adequate oxygen delivery and utilization. Careful attention to each organ-system is of paramount importance to prevent complications and improve outcome. Experimental therapies to modulate the inflammatory response are promising.
Topics: Acute-Phase Proteins; Adolescent; Child; Child, Preschool; Critical Care; Hemodynamics; Humans; Infant; Oxygen; Shock, Septic
PubMed: 7504655
DOI: 10.1007/BF02751198 -
Clinical Obstetrics and Gynecology Jun 1970
Review
Topics: Abortion, Criminal; Abortion, Septic; Anti-Bacterial Agents; Blood Coagulation; Cardiac Output; Cardiovascular System; Central Venous Pressure; Female; Glucocorticoids; Humans; Hysterectomy; Pregnancy; Shock, Septic; Shwartzman Phenomenon; Sympathomimetics
PubMed: 4923486
DOI: 10.1097/00003081-197006000-00006 -
Lancet (London, England) Jul 1978
Topics: Humans; Intermittent Positive-Pressure Breathing; Positive-Pressure Respiration; Shock, Septic
PubMed: 78414
DOI: 10.1016/s0140-6736(78)91955-4 -
Current Opinion in Anaesthesiology Apr 2021
Topics: Humans; Sepsis; Shock, Septic
PubMed: 33652453
DOI: 10.1097/ACO.0000000000000964