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    Septic shock is the most severe form of infection and occurs when sepsis leads to dangerously low blood pressure despite fluid resuscitation. It results from systemic inflammation caused by infection that leads to vasodilation and poor blood flow distribution. Treatment focuses on early antibiotics, source control, fluid resuscitation, vasopressors, inotropes, steroids, activated protein C and supportive care of organs to prevent multiple organ dysfunction. The goal is to restore blood pressure, cardiac output and tissue perfusion through clinical and hemodynamic goals.

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    Septic shock is the most severe form of infection and occurs when sepsis leads to dangerously low blood pressure despite fluid resuscitation. It results from systemic inflammation caused by infection that leads to vasodilation and poor blood flow distribution. Treatment focuses on early antibiotics, source control, fluid resuscitation, vasopressors, inotropes, steroids, activated protein C and supportive care of organs to prevent multiple organ dysfunction. The goal is to restore blood pressure, cardiac output and tissue perfusion through clinical and hemodynamic goals.

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    595 views11 pages

    Septic Shock

    Uploaded by

    j.doe.hex_87
    Septic shock is the most severe form of infection and occurs when sepsis leads to dangerously low blood pressure despite fluid resuscitation. It results from systemic inflammation caused by infection that leads to vasodilation and poor blood flow distribution. Treatment focuses on early antibiotics, source control, fluid resuscitation, vasopressors, inotropes, steroids, activated protein C and supportive care of organs to prevent multiple organ dysfunction. The goal is to restore blood pressure, cardiac output and tissue perfusion through clinical and hemodynamic goals.

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    of 11

    SEPTIC SHOCK

    DISTRIBUTIVE SHOCK
    Definition
    - type of shock result of loss of vasomotor control (vascular tone),
    resulting artheriolar and venular vasodilatation and
    maldistribution of bood flow (coexistence of hypoperfusion and
    hyperperfusion areas ).

    FORMS
    – Septic shock
    – Anaphylactic shock
    – Neurogenic shock
    – Endocrine shock
    – Toxic shock
    – Traumatic shock without hypovolemia
    SEPTIC SHOCK
    Septic shock is the most severe form of infection.

    CONTINUUM OF SEVERITY

    SIRS → sepsis → severe sepsis →septic shock→MODS


    →MSOF
    DEFINITIONS
    – Infection – inflammatory reaction caused by the presence
    of mycroorganisms in a normally sterile tissue;
    – SIRS (systemic inflammatory response syndrome) –
    • Temperature > 38º C or < 36º C
    • Heart rate > 90 beats/minute
    • Respiratory rate > 20 breaths/minute or PaCO2< 32mmHg
    • White blood cell count >12.000/mm3 sau < 4000/mm3 or >10%
    immature forms
    – Sepsis – SIRS caused by an infection
    – Severe sepsis – sepsis + organ dysfunction or metabolic
    acidosis
    – Septic shock – sepsis associated with persistent arterial
    hypotension despite adequate fluid resuscitation
    – Multiple organ dysfunction/failure system( MODS/MSOF)
    acute dysfunctions/failure of multiple organs functions
    SEPTIC SHOCK
    Septic shock is the most severe form of infection.

    CONTINUUM OF SEVERITY

    SIRS → sepsis → severe sepsis →septic


    shock→MODS →MSOF
    SEPTIC SHOCK
    PATHOPHYSIOLOGY
    - The infection causes the proliferation of pathogens and/or
    the release of their components (endotoxin, techoic
    acid,etc.) in blood circulation
    – The body response consist in:
    • Cellular response (activated macrophages, monocytes, neutrophils,
    endothelial cells)
    • Humoral response (cytokines: TNF, IL, FAP, PG, LTR, NO,RO,etc.)
    • Activation of the complement and of the coagulation system
    – Hemodynamic:
    • Macrocirculatory: altered systolic and diastolic heart function
    peripheral vasodilation
    • Microcirculatory: difuse endhotelial inflammation
    arterial-venous shunts
    microvascular thrombosis
    • Metabolic: hypercatabolism
    SEPTIC SHOCK
    Clinical signs
    • Hyperthermia or hypothermia
    • Tachycardia
    • Tachypnea
    • Altered mental status (septic encephalopathy )
    • Arterial hypotension
    • Warm extremities
    • Large pulse wave
    • Good colour return to the nail bed
    • Full peripheral veins
    • Oliguria
    HEMODYNAMIC PARAMETERS IN
    DIFFERENT TYPES OF SHOCK
    • With defferent types of shock

    FC TA DC PVC PCPB RVP Da-vO2 SvO2

    Hypovolemic ↑ ↓ ↓ ↓ ↓ ↑ ↑ ↓
    shock

    Cardiogenic ↑ ↓↓ ↓ ↑ ↑ ↑ ↑ ↓
    shock

    Septic shock ↑ ↓ N ↑ ↓N N ↓ ↓ ↑
    SEPTIC SHOCK
    TREATMENT PRINCIPLES
    SURVIVING SEPSIS CAMPAIGN – 2004
    1. Initial resuscitation (first 6 hours):
    • CVP 8-12mmHg
    • Mean TA >65mmHg
    • SvO2> 70%
    • Urine output >0,5ml/kg /h
    2. Cultures:
    • Blood cultures
    • Cultures from the suspected phatologycal product
    3. Antibiotic therapy
    • Early (in the first hour after recognition of septic shock)
    • Empirical – broad spectrum, active on suspected pathogens
    • Association of antibiotics ; large doses; intravenous administration, adapted to
    pharmacokinetic
    • at 48 hours– deescalation therapy
    4. Controling the source of infection
    • Surgical procedure for eradication of the source of infection
    SEPTIC SHOCK
    TREATMENT PRINCIPLES

    5. Volume repletion therapy (crystalloids or colloids)


    • Normalization of intravascular volume and PVC
    5. Vasopressor therapy
    Normalization of bood pressure and organ perfusion
    5. Inotropic therapy
    • Normalization of cardiac output
    • The drog of choice is dobutamine (when needs, with norepinephirine)
    5. Corticosteroids therapy
    • HHC 50 mg/6 hours
    5. Activated protein C (Xygris) therapy
    • Anticoagulation and antiinflammatory effect
    10. Blood transfusion
    • Restoring oxygen delivery
    • Hb 7-9g/l
    SEPTIC SHOCK
    PRINCIPLES OF TREATMENT
    11. Ventilatory support
    • Protective lung ventilation
    11. Sedation, analgesia and muscle relaxation
    • Always adequate analgesia, sometimes sedation - of the mecanically ventilated
    patient, muscle relaxation only if is necessary
    11. Glycemic control
    • Maintain serum glucose < 150mg%
    11. Renal replacement therapy
    • Continuous venovenous hemofiltration / intermittent hemodialysis
    11. Bicarbonate therapy
    • Treatment of metabolic acidosis at pH <7,15

    11. Prevention of deep venous thrombosis


    • Low molecular weight heparin
    11. Stress ulcer prophylaxis
    • omeprazol
    11. Limited vital support
    • Taking in consideration
    11. in the cases without chances of healing– sedation , analgesia and hydration

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