Septic shock

Septic shock is sepsis with circulatory, cellular, and metabolic abnormalities severe enough to increase its mortality.

It is a type of circulatory shock and is characterized by arterial hypotension, which is caused by a generalized decrease in peripheral resistance. It is essentially a distribution shock. It occurs more often in people with reduced immunity. After cardiogenic shock, it is the most common type of shock causing death in hospitals.

Cause
Septic shock is caused by bacteremia. As a rule, Gram negative bacteria that enter the circulation act with endotoxin (the lipopolysaccharide of their outer shell). But it can also be Gramm positive - an exotoxin or Candida (yeast) acts.

The role of pro-inflammatory cytokines TNF and IL-1, together with endotoxin, induces the expression of the gene for iNOS.

Characteristics
Pathological generalized vasodilatation (not related to the nutritional needs of the tissues, nor to thermoregulation) – Uncontrolled production of NO caused by the expression of the gene for the inducible form of NO-synthase (i-NOS) in macrophages and endothelium.

High fever and generalized inflammation => increased level of cellular metabolism.

Increased cardiac output - Less afterload => greater ejection fraction, tachycardia (sympatho-adrenal activation), septic shock = "hypercirculatory shock".

Further development
Decreased performance and contractility of the myocardium leads to worsening of arterial hypotension. Increased permeability of capillaries, formation of edema, decrease in circulating volume also lead to deterioration of hypotension. Possible development of disseminated intravascular coagulation (DIC).

Therapy
Treatment must be intensive and must be started on time!


 * Replenishment of circulating volume by infusions,
 * Breathing support
 * Use of antibiotics.

Related Articles

 * Shock
 * Hypovolemic shock
 * Obstructive shock
 * Distribution shock
 * Cardiogenic shock
 * Circulatory collapse