Septic shock

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

Septic shock is a serious medical condition caused by decreased tissue perfusion and oxygen delivery as a result of infection and sepsis. It can cause multiple organ failure and death. Its most common victims are children, immunocompromised individuals, and the elderly, as their immune systems cannot cope with the infection as well as those of full-grown adults. The mortality rate from septic shock is approximately 50%.

Septic shock

Septic shock is defined as sepsis with refractory arterial hypotension. Refractory arterial hypotension is further defined as:

• Mean systemic blood pressure (SBP) of < 60 mm Hg or < 80 mm Hg (in hypertensives) despite adequate fluid resuscitation.
  • Adequate fluid resuscitation is defined as infusion of following at the said rates:
    • 20 to 30 mL/kg of starch,
    • 40 to 60 mL/kg of saline solution
    • Measured pulmonary capillary wedge pressure - 12 to 20 mmHg
    • Central venous pressure of 8 to 12 mmHg
• Maintenance of the systemic mean blood pressure of >60 mmHg or >80 mmHg (in hypertensives) despite adequate fluid resuscitation requires
  • Dopamine > 5 mcg/kg/min
  • Norepinephrine < 0.25 mcg/kg/min
  • Epinephrine < 0.25 mcg/kg/min

Types

A subclass of distributive shock, shock refers specifically to decreased tissue perfusion resulting in end-organ dysfunction. Cytokines TNFα, IL-1β, IL-6 released in a large scale inflammatory response results in massive vasodilation, increased capillary permeability, decreased systemic vascular resistance, and hypotension. Hypotension reduces tissue perfusion pressure and thus tissue hypoxia ensues. Finally, in an attempt to offset decreased blood pressure, ventricular dilatation and myocardial dysfunction will occur.

Causes

The process of infection by bacteria or fungi can result in systemic signs and symptoms that are variously described. In rough order of severity, these are bacteremia or fungemia; septicemia; sepsis, severe sepsis or sepsis syndrome; septic shock; refractory septic shock; multiple organ dysfunction syndrome, and death.

The condition develops as a response to certain microbial molecules which trigger the production and release of cellular mediators, such as tumor necrosis factors (TNF); these act to stimulate immune response. Besides TNFα, other cytokines involved in the development of septic shock include interleukin-1β, and interferon γ.

See also

• Anaphylactic shock
• Cardiogenic shock
• Neurogenic shock
• Sepsis
• Shock
• Systemic inflammatory response syndrome (SIRS)

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