Septic Shock

Topics: Shock, Blood, Systemic inflammatory response syndrome Pages: 5 (366 words) Published: April 23, 2012
Pathologic Mechanisms of Septic Shock
Kenneth J. Goodrum, Ph.D. OUCOM

● ● ● ● ●

● ●

Definitions: SIRS,sepsis,shock,MODS Morbidity/mortality of Sepsis/Shock Pathogenesis of shock Microbial triggers(endotoxin, TSSTs) Cytokine and non-cytokine mediators of SIRS and shock Pathophysiology of shock Therapy

Systemic Inflammatory Response Syndrome (SIRS)

● ● ●

Systemic inflammatory response to a variety of severe clinical insults manifested by ≥ 2 of the following conditions Temperature >38ºC or 90 beats/min Respiratory rate >20 breaths/min or PaCO2 ,100 beats/min) Increased cardiac output (hyperdynamic), although contractility is depressed; hypodynamic in late shock Ventricular dilation; decreased ejection fraction Loss of sympathetic responsiveness

● ●

● ●


Hypovolemia due to vascular leakage; central venous pressure may be decreased or increased depending upon fluid resuscitation Compromised nutrient blood flow to organs; decreased organ oxygen extraction

Pulmonary & Renal
● ● ● ● ● ● ●

Hyperventilation with respiratory alkalosis Pulmonary hypertension and edema Hypoxemia (arterial pO2 < 50 mmHg) Reduced pulmonary compliance; increased work Respiratory muscle failure Renal hypoperfusion; oliguria Acute tubular necrosis and renal failure

● ●

Disseminated intravascular coagulation (DIC) Blood dyscrasias – leukopenia – thrombocytopenia – polycythemia

● ●

Central and peripheral nervous dysfunction Increased lactate occurs early

Therapies of Sepsis/Septic Shock
● ●

Antibiotics (early administration) Hemodynamic support
– (fluid resuscitation)
● ●

Restore tissue perfusion Normalize cellular metabolism Dopamine, norepinephrine, dobutamine

– Vasopressor agents

Therapies of Sepsis/Septic Shock (cont.)

Source control
– Surgical debridement of infected, devitalized tissue – Catheter replacement

Supplemental oxygen (treatment of acute respiratory distress syndrome,ARDS) Nutritional support

Controversial Current Therapies for Septic Shock

Anti-inflammatory agents
– – – – Cortocosteroids Ibuprofen Prostaglandin E1 Pentoxifylline

Oxygen Scavengers
– N-acetylcysteine – selenium

Controversial Current Therapies for Septic Shock(cont.)

Drugs modifying coagulation
– Anti-thrombin III

Drugs enhancing host defenses
– – – – Intravenous immunoglobulin (IVIG) Interferon-gamma GM-CSF immunonutrition

Controversial Current Therapies for Septic Shock(cont.)

Other drugs
– Growth hormone, antibiotics, fresh frozen plasma, anesthetic sedative and analgesic agents, catecholamines

Hemofiltration, plasma filtration, plasma exchange

Experimental Therapies of Sepsis/Septic Shock

Anti-endotoxin therapies
– IVIG, BPI protein

● ● ● ● ●

IL-1Ra Anti-TNF-alpha, soluble TNFR PLA2 inhibitors, PAF inhibitors iNOS inhibitors Anti-coagulants (APC)


Immunological therapy of sepsis:experimental therapies. P. Arndt and E. Abraham. Intensive Care med (201)27:S104-115. Immunological therapy in sepsis:currently available. J.Carlet. Intensive Care Med (2001)27:S93-S103.

Continue Reading

Please join StudyMode to read the full document

You May Also Find These Documents Helpful

  • Types of Shock Essay
  • Hypovolemic Shock Essay
  • Essay about Hypovolemic Shock
  • Chapter 67 Nursing Management Shock Systemic Inflammatory R Essay
  • Septic Shock vs Cardiogenic Shock Essay
  • Shock Collars and Dogs Essay
  • Shock and Superior Experiment Essay
  • Culture Shocks Essay

Become a StudyMode Member

Sign Up - It's Free