What is septic shock and how does it differ from sepsis. How does septic shock affect the body and what are its complications. Who is at higher risk of developing septic shock. Why is early treatment crucial for septic shock patients. How can septic shock lead to long-term health issues.

Defining Sepsis and Septic Shock: A Comprehensive Overview

Sepsis is a life-threatening condition that occurs when the body’s response to infection spirals out of control. It can progress rapidly, leading to severe sepsis and ultimately, septic shock. But what exactly distinguishes septic shock from sepsis?

Septic shock is the most severe form of sepsis, characterized by a significant drop in blood pressure that can lead to organ failure and death. It represents a medical emergency requiring immediate and intensive treatment.

The Progression from Sepsis to Septic Shock

The journey from sepsis to septic shock can be alarmingly swift. Here’s how it typically unfolds:

1. Sepsis: The initial stage where the body’s response to infection becomes dysregulated.
2. Severe sepsis: One or more organs begin to fail due to the overwhelming infection.
3. Septic shock: Blood pressure drops dangerously low, compromising organ function and potentially leading to death.

Understanding this progression is crucial for both medical professionals and the general public to recognize the urgency of sepsis and seek treatment promptly.

The Hidden Danger: Sepsis in the Community

Contrary to popular belief, sepsis isn’t confined to hospital settings. In fact, up to 87% of sepsis cases originate from infections contracted in everyday environments like homes, workplaces, or schools. This statistic underscores the importance of public awareness about sepsis and its symptoms.

Why is community-acquired sepsis so prevalent? Several factors contribute to this phenomenon:

• Lack of awareness about sepsis symptoms
• Delayed seeking of medical attention
• Underlying health conditions that increase susceptibility to infections
• Poor hygiene practices in community settings

Recognizing the signs of sepsis early can make a significant difference in outcomes. These may include fever, rapid heart rate, difficulty breathing, and confusion.

The Race Against Time: Treating Septic Shock

When it comes to septic shock, time is of the essence. Every hour that treatment is delayed increases the risk of death by 4% to 9%. This stark reality emphasizes the critical nature of early recognition and rapid intervention.

What does effective treatment for septic shock involve? The primary components include:

• Intravenous (IV) fluids to restore blood volume and pressure
• Broad-spectrum antibiotics to combat the underlying infection
• Vasopressors to help maintain blood pressure
• Oxygen therapy to support organ function
• Continuous monitoring and support of vital organ functions

Healthcare providers must act swiftly and decisively to implement these interventions, often in intensive care settings where patients can receive round-the-clock monitoring and support.

Unequal Impact: Disparities in Septic Shock Outcomes

Septic shock doesn’t affect all populations equally. Certain communities face higher risks and worse outcomes, highlighting significant healthcare disparities that demand attention.

How do these disparities manifest? Consider these sobering statistics:

• Black and Hispanic children are 25% more likely to die from severe sepsis or septic shock compared to non-Hispanic white children.
• American Indians and Alaskan Native people in the Indian Health Service area have a 1.6 times higher likelihood of dying from sepsis than the national average.

These disparities stem from complex factors, including:

• Limited access to healthcare services
• Socioeconomic barriers
• Cultural differences in healthcare-seeking behaviors
• Potential biases in healthcare delivery

Addressing these disparities requires a multifaceted approach, involving improved healthcare access, culturally competent care, and targeted public health initiatives.

The Domino Effect: How Septic Shock Impacts the Body

Septic shock sets off a cascade of physiological changes that can have devastating effects on multiple organ systems. Understanding these impacts is crucial for appreciating the severity of this condition.

The Blood Pressure Crisis

At the heart of septic shock is a dramatic drop in blood pressure. But why is this so dangerous? When blood pressure falls below 90/60 mmHg (hypotension), it compromises the body’s ability to deliver oxygen and nutrients to vital organs and tissues.

This inadequate blood flow can lead to:

• Organ dysfunction or failure
• Tissue death, particularly in extremities
• Cognitive impairment
• Metabolic imbalances

The Organ Systems Under Siege

Septic shock can affect virtually every organ system in the body. Here’s how different systems may be impacted:

• Respiratory System: Acute respiratory distress syndrome (ARDS) may develop, necessitating mechanical ventilation.
• Cardiovascular System: The heart may struggle to pump effectively, leading to further blood pressure instability.
• Renal System: Acute kidney injury is common, sometimes requiring temporary or permanent dialysis.
• Hepatic System: Liver function may be compromised, affecting metabolism and detoxification processes.
• Neurological System: Confusion, delirium, or even coma can occur due to inadequate brain perfusion.
• Coagulation System: Abnormal blood clotting can lead to both bleeding and clotting complications.

The interplay of these systemic effects contributes to the complexity and severity of septic shock, making it one of the most challenging conditions to treat in critical care settings.

Beyond Survival: Long-Term Consequences of Septic Shock

While the immediate goal in treating septic shock is survival, the journey doesn’t end there for many patients. Survivors often face a range of long-term health issues that can significantly impact their quality of life.

Physical Aftermath

What physical challenges might septic shock survivors encounter? Common issues include:

• Chronic pain
• Persistent fatigue
• Organ dysfunction
• Amputations due to tissue death
• Weakened immune system

These physical consequences can lead to reduced mobility, increased dependence on medical interventions, and a need for ongoing healthcare support.

Psychological Impact

The trauma of septic shock extends beyond the physical realm. Many survivors grapple with significant psychological challenges, including:

• Post-traumatic stress disorder (PTSD)
• Depression and anxiety
• Cognitive impairments, often referred to as “post-sepsis syndrome”
• Adjustment disorders related to lifestyle changes

These mental health issues can be as debilitating as the physical effects, highlighting the need for comprehensive post-sepsis care that addresses both body and mind.

Socioeconomic Consequences

The ripple effects of septic shock often extend into patients’ social and economic lives. Survivors may face:

• Inability to return to work or previous levels of productivity
• Financial strain due to ongoing medical costs and lost income
• Changes in family dynamics and relationships
• Reduced participation in social activities

These far-reaching impacts underscore the importance of viewing septic shock not just as an acute medical emergency, but as a condition with potentially lifelong consequences that require ongoing support and management.

Preventing the Preventable: Strategies to Reduce Sepsis and Septic Shock

Given the severe consequences of septic shock, prevention becomes paramount. While not all cases of sepsis can be prevented, there are strategies that can significantly reduce the risk.

Infection Prevention

Since sepsis always starts with an infection, preventing infections is the first line of defense. Key strategies include:

• Proper hand hygiene
• Vaccination against common infectious diseases
• Prompt treatment of wounds and infections
• Proper care of medical devices like catheters and breathing tubes

Early Recognition and Treatment

When prevention fails, early recognition becomes crucial. Public awareness campaigns can help people identify sepsis symptoms early. Healthcare providers should implement sepsis screening protocols to catch cases early and initiate prompt treatment.

Management of Chronic Conditions

People with chronic health conditions are at higher risk for sepsis. Proper management of these conditions can reduce the risk:

• Diabetes management
• Heart disease control
• Proper care for individuals with compromised immune systems

Antibiotic Stewardship

Proper use of antibiotics is crucial in preventing antibiotic-resistant infections, which can lead to more severe cases of sepsis. Healthcare systems should implement antibiotic stewardship programs to ensure appropriate antibiotic use.

By implementing these preventive strategies at both individual and systemic levels, we can work towards reducing the incidence of sepsis and septic shock, ultimately saving lives and improving health outcomes.

The Future of Septic Shock Management: Emerging Therapies and Research

As our understanding of sepsis and septic shock evolves, so do the approaches to treatment and management. Researchers and clinicians are exploring innovative therapies that hold promise for improving outcomes in septic shock patients.

Personalized Medicine Approaches

One of the most exciting areas of research involves tailoring treatments to individual patients based on their genetic makeup and specific biomarkers. This personalized approach could lead to more effective and targeted therapies.

What might personalized sepsis treatment look like?

• Genetic testing to predict individual responses to different antibiotics
• Biomarker-guided therapy to tailor fluid resuscitation and vasopressor use
• Immunomodulatory treatments based on a patient’s specific immune response

Innovative Therapies

Several novel treatments are currently under investigation or in early stages of clinical use:

• Extracorporeal blood purification techniques to remove inflammatory mediators
• Stem cell therapies to promote tissue repair and modulate the immune response
• Targeted molecular therapies to address specific pathways involved in sepsis progression
• Artificial intelligence-driven monitoring systems for early detection and management

Advancements in Supportive Care

While breakthrough treatments are exciting, improvements in supportive care are equally important. These include:

• Enhanced ventilation strategies to minimize lung injury
• Improved fluid management protocols
• Advanced hemodynamic monitoring techniques
• Nutritional support tailored to the hypermetabolic state of sepsis

As research progresses, the hope is that these advancements will translate into improved survival rates and better quality of life for septic shock survivors.

Global Impact: Septic Shock as a Public Health Challenge

Septic shock is not just a medical emergency; it’s a significant public health challenge with global implications. Understanding its widespread impact is crucial for developing comprehensive strategies to combat this condition.

The Global Burden

Sepsis and septic shock affect millions worldwide, with staggering statistics:

• Approximately 50 million cases of sepsis occur globally each year
• Sepsis accounts for about 20% of all deaths worldwide
• Low- and middle-income countries bear a disproportionate burden of sepsis cases and deaths

Economic Impact

The economic toll of sepsis and septic shock is enormous, affecting healthcare systems and economies:

• High costs of intensive care treatment
• Long-term healthcare expenses for survivors
• Lost productivity due to mortality and long-term disabilities

Global Health Security

Sepsis and septic shock are intertwined with other global health challenges:

• Antibiotic resistance can make sepsis more difficult to treat
• Sepsis can be a complication of pandemic diseases, as seen with COVID-19
• Improving sepsis care is crucial for achieving global health goals, including reducing maternal and child mortality

International Efforts

Recognizing the global nature of this challenge, international efforts are underway to combat sepsis and septic shock:

• World Health Organization’s resolution on sepsis, emphasizing its importance as a global health priority
• Global Sepsis Alliance’s efforts to raise awareness and improve care worldwide
• International collaborations for research and guideline development

Addressing septic shock on a global scale requires coordinated efforts, resource allocation, and a commitment to improving healthcare systems worldwide. Only through such comprehensive approaches can we hope to reduce the global burden of this devastating condition.

Septic Shock | Sepsis Alliance

Septic shock is the final, most severe form of sepsis and also the most difficult to treat. Patients in septic shock are often called the “sickest patients in the hospital,” as doctors, nurses, and other healthcare professionals work to save them from long-lasting complications or death.

People are more likely to develop sepsis in the community than in the hospital – up to 87% of cases start from infections people contracted at work, school, or home. Sepsis can start gradually, or the symptoms can come on very suddenly. Sepsis must be treated quickly and efficiently as soon as healthcare providers suspect it. If it isn’t recognized and treated quickly, sepsis can progress to severe sepsis and then to septic shock.

Sepsis, which was often called blood poisoning, is the body’s life-threatening response to infection or injury. Like strokes or heart attacks, sepsis is a medical emergency that requires rapid diagnosis and treatment. Sepsis kills and disables millions and requires early suspicion and rapid treatment for survival. Septic shock disproportionately affects certain communities, increasing their disability and mortality rates. Black and Hispanic children are 25% more likely to die from severe sepsis or septic shock than non-Hispanic white children. American Indians and Alaskan Native people in the Indian Health Service area are 1.6 times more likely to die from sepsis than the national average.

Sepsis and septic shock can result from an infection anywhere in the body, such as pneumonia, influenza, urinary tract infections, or even from a cut on the finger that becomes infected. Worldwide, one-third of people who develop sepsis die. Many who do survive are left with life-changing effects, such as post-traumatic stress disorder (PTSD), chronic pain and fatigue, organ dysfunction (organs don’t work properly), and/or amputations.

When Sepsis Becomes Septic Shock

Sepsis treatment usually requires intravenous (IV) fluids and antibiotics. It is essential that the treatment begin as early as possible. The chance of sepsis progressing to severe sepsis and septic shock, causing death, rises by 4% to 9% for every hour treatment is delayed.

Severe sepsis occurs when one or more of your organs stop working effectively. For example, you could need a ventilator to help you breathe or dialysis to filter toxins from your blood. Any organ can be affected.

People with severe sepsis are already very ill, but if your blood pressure starts to drop, you become even sicker. You go into septic shock. The medical definition of “shock” is a drop or fall in blood pressure. When it is associated with sepsis, it is called septic shock.

 

 

Why Septic Shock Is Dangerous

As your heart pumps blood throughout your body, it produces a certain amount of pressure to help push the blood through the blood vessels. The blood then delivers oxygen and nutrients to the organs and other body tissues. It also removes toxins. The average blood pressure for a healthy adult is around 120/80 mmHg. Hypotension, or low blood pressure, occurs when the blood pressure drops to below 90/60. If you are hypotensive, your blood does not have enough force behind it to circulate properly throughout your body. The tissues don’t get the nutrients they need.

Temporary hypotension, caused by dehydration, overheating, or even psychological shock can cause dizziness, nausea, and fainting. Usually, those situations resolve when the cause is treated, and the blood pressure and blood flow throughout the body return to normal. But when hypotension is extended, like in septic shock, the prolonged blood pressure drop can cause many complications.

Septic Shock Complications

One of the most serious septic shock complications is organ damage. In some cases, the damage may only be temporary. For example, a person in septic shock may develop acute kidney injury. The kidneys are not able to filter out the toxins from the blood. If this occurs, the patient may need dialysis, a procedure where a machine acts as the body’s kidneys to cleanse the blood. As the body heals, the kidneys may begin functioning again. But in many cases, organ damage is permanent.

Another serious septic shock complication is tissue death (gangrene) that leads to amputations. Not only does hypotension reduce the blood flow to the less vital parts of the body, like the feet and hands, people with severe sepsis or septic shock can develop tiny blood clots in the blood vessels. These clots can block blood that tries to reach the area, resulting in tissue death.

If too much of the tissue has died, a surgeon must remove it to prevent the dead tissue from spreading. Some septic shock survivors must have the tips of fingers and toes removed, while others lose one or both legs, or even all four limbs.

Accurate statistics regarding sepsis-related amputations are not easily available, but a study presented in 2019 looked at 1.5 million sepsis survivors in the United States and the researchers found that one out of every 100 survivors had an amputation within 90 days of their sepsis diagnosis. Most amputations were of the lower limbs.

Septic Shock Treatment

Treating septic shock focuses on increasing the blood pressure, eliminating the infection that triggered the sepsis, and providing support for the organs that are failing. Some treatments could include:

• IV fluids to raise blood pressure.
• Medications, including antimicrobials (antibiotics, antivirals), drugs to increase blood pressure, pain relievers, and any other medications to treat immediate issues.
• Oxygen, either by mask or nasal cannula, or with a ventilator, to help raise oxygen levels in the blood.
• Surgery, which may be necessary to remove the source of infection, such as gallstones or an inflamed appendix.

Once the blood pressure is back up to normal levels and it stays there, the patient is no longer in septic shock. The patient is still very ill, but no longer with a too-low blood pressure.

After Septic Shock

Most often, you can be discharged from the ICU once your blood pressure is stable and supportive treatment, like a ventilator or dialysis, are no longer required. You will still be monitored and cared for, but in a lower-acuity ward or unit.

Recovering from septic shock can take longer than you may expect. Survivors may appear to be better, but many live with long-lasting effects from having been so ill. Up to 50% of sepsis survivors live with post-sepsis syndrome (PSS), which can be mild or severe. Signs of PSS can include:

• Insomnia
• Chronic pain
• Chronic fatigue
• Hair loss
• Memory issues
• Frequent infections

About one-third of sepsis survivors return to the hospital within three months of their discharge. The most common causes are repeat infection or sepsis. You can learn more from the Life After Sepsis Fact Sheet.

If you or someone you know shows any signs of sepsis, this is a medical emergency and you must seek medical help immediately to reduce the risk of septic shock.

 

Would you like to share your story about sepsis or read about others who have had sepsis? Please visit Faces of Sepsis, where you will find hundreds of stories from survivors and tributes to those who died from sepsis.

Suggested Citation: Sepsis Alliance. Sepsis and Septic Shock. 2022. https://www.sepsis.org/sepsisand/septic-shock/

Updated July 12, 2022.

Symptoms, Causes, Diagnosis, Treatment & More

Sepsis occurs when your body has an extreme reaction to an infection. This reaction causes drastic changes in the body and can be very dangerous and potentially life threatening.

Doctors have identified three stages of sepsis:

• Sepsis. An infection reaches the bloodstream and causes inflammation in the body.
• Severe sepsis. The infection is severe enough to affect organ function.
• Septic shock. There’s a significant drop in blood pressure that can lead to respiratory or heart failure, stroke, dysfunction of other organs, and possibly death.

Sepsis is most often caused by bacterial infections, but almost any infection can cause sepsis if left untreated. Both both sepsis and septic shock can happen to anyone.

Septic shock is a severe complication of sepsis that can include very low blood pressure, an altered mental state, and organ dysfunction. It has a hospital mortality rate of 30–50 percent, making it very dangerous if not treated quickly.

The earlier sepsis is diagnosed, the quicker doctors can treat it and attempt to keep it from turning into septic shock.

Sepsis is a medical emergency, but in the beginning, its symptoms can often mimic the symptoms of other issues, such as a cold or fever.

If you or someone you know has recently had an infection that doesn’t seem to be improving or has started exhibiting these symptoms, it’s possible it may be sepsis:

• high fever or chills
• intense body pain
• fast heart rate
• rapid breathing
• rash

While these symptoms could be signs of another health issue, it’s always a good idea to contact a doctor or go to the hospital if you’re worried that you or someone you are caring for seems to be deteriorating.

The transition from the onset of sepsis to severe sepsis and septic shock can happen quickly, and once the condition has transitioned, the mortality rate can increases. The symptoms of severe sepsis and septic shock can overlap, and can include:

• noticeably lower amounts of urine
• acute confusion
• dizziness
• severe problems breathing
• bluish discoloration of the digits or lips (cyanosis)

Specifically, people experiencing septic shock will also have very low blood pressure that doesn’t respond to fluid replacement and have abnormalities in blood flow which can result in organ dysfunction.

Sepsis can result from a bacterial, fungal, or viral infection. These infections may begin at home or while you’re in the hospital for treatment of another condition.

Sepsis commonly originates from:

• abdominal or digestive system infections
• lung infections like pneumonia
• urinary tract infection
• reproductive system infection

Septic shock is what happens when sepsis itself isn’t diagnosed or treated in time.

Certain factors such as age or prior illness can put you at greater risk for developing septic shock.

The people who are more vulnerable to sepsis include newborns, older adults, pregnant people, and those with suppressed immune systems due to HIV, autoimmune conditions, cirrhosis of the liver, kidney disease, and cancer.

The following factors could also make a sepsis diagnosis — and possibly septic shock — more likely:

• recovering from surgery or being in the hospital for a long time
• living with diabetes
• being exposed to devices like intravenous catheters, urinary catheters, or breathing tubes, which can introduce bacteria into the body
• taking immunosuppressant drugs

If you have symptoms of sepsis, your doctor or another hospital professional will conduct tests to determine how far along the infection is.

These tests can help determine what germ actually caused the infection that led to sepsis, as well as whether any additional bacterial infections are present and whether there’s organ damage.

In cases where the source of the infection isn’t clear from the tests above, a doctor could also apply the following methods of getting an internal view of your body:

• X-rays
• CT scan
• MRI

Septic shock is typically diagnosed when the signs of severe sepsis are present, along with low blood pressure and signs of organ dysfunction.

Septic shock can cause a variety of very dangerous and life threatening complications that can be fatal. Possible complications include:

• heart failure
• abnormal blood clotting
• kidney failure
• respiratory failure
• stroke
• liver failure

The complications you may experience, and the outcome of your condition can depend on certain factors, such as:

• age
• how soon treatment is started
• the cause and origin of sepsis within the body
• preexisting medical conditions

The earlier sepsis is diagnosed and treated, the less likely septic shock will develop, and the more likely you are to survive.

Doctors use a number of medications to treat septic shock, including:

• intravenous antibiotics to fight infection
• vasopressor medications, which are drugs that constrict blood vessels and help increase blood pressure
• insulin for blood sugar stability
• corticosteroids

Large amounts of intravenous (IV) fluids will likely be administered to treat dehydration and help increase blood pressure and blood flow to the organs. A respirator for breathing may also be necessary.

Surgery may be performed to remove a source of infection, such as draining a pus-filled abscess or removing infected tissue.

Many individuals who survive sepsis recover completely. However, if your sepsis developed into a more severe form or septic shock, certain post-recovery side effects are possible, including:

• muscle weakness
• fatigue
• difficulty swallowing
• brain fog
• poor memory
• sleeping issues
• sadness
• anxiety

Some people who recover from sepsis may be at a high risk of additional infections because of the time it takes the immune system to completely recover, which could be anywhere from several weeks to months.

If your muscle weakness is extensive, your doctor may recommend physical therapy.

Septic shock is a severe complication of sepsis. Your chances of recovering from septic shock will depend on the source of the infection, how many organs have been affected, and how soon you receive treatment after you first begin experiencing symptoms of sepsis.

While it’s possible to make a full recovery from sepsis and even septic shock, the quicker symptoms are addressed, the better your chances are for a full recovery.

Septic shock – Vascular Innovation Center article

Septic shock is a systemic pathological reaction to severe infection. It is characterized by fever, tachycardia, tachypnea, leukocytosis when identifying the focus of the primary infection. At the same time, microbiological examination of blood often reveals bacteremia. In some patients with sepsis syndrome, bacteremia is not detected. When arterial hypotension and multiple systemic insufficiency become components of the sepsis syndrome, the development of septic shock is ascertained.

Causes and pathogenesis of septic shock:

The frequency of sepsis and septic shock has been steadily increasing since the thirties of the last century and, apparently, will continue to increase.
The reasons for this are:

1. Increasing use of invasive devices for intensive care, i.e. intravascular catheters, etc.

2. Widespread use of cytotoxic and immunosuppressive agents (in malignant diseases and transplants), which cause acquired immunodeficiency.

3. Increased life expectancy in patients with diabetes mellitus and malignant tumors, who have a high level of predisposition to sepsis.

Bacterial infection is the most common cause of septic shock. In sepsis, the primary foci of infection are more often localized in the lungs, abdominal organs, peritoneum, and also in the urinary tract. Bacteremia is detected in 40-60% of patients in a state of septic shock. In 10-30% of patients in a state of septic shock, it is impossible to isolate a culture of bacteria whose action causes septic shock. It can be assumed that septic shock without bacteremia is the result of an abnormal immune reaction in response to stimulation with antigens of bacterial origin. Apparently, this reaction persists after the elimination of pathogenic bacteria from the body by the action of antibiotics and other elements of therapy, that is, it is endogenized.
The endogenization of sepsis can be based on numerous, reinforcing each other and realized through the release and action of cytokines, interactions of cells and molecules of innate immunity systems and, accordingly, immunocompetent cells.

Sepsis, systemic inflammatory response, and septic shock are the result of an overreaction to bacterial antigen stimulation of innate immune cells. The overreaction of the cells of the innate immunity systems and the reaction of T-lymphocytes and B-cells secondary to it cause hypercytokinemia. Hypercytokinemia is a pathological increase in the blood levels of agents of auto-paracrine regulation of cells that carry out innate immunity reactions and acquired immune reactions.

In case of hypercytokinemia, the content of primary pro-inflammatory cytokines, tumor necrosis factor-alpha and interleukin-1 abnormally increases in the blood serum. As a result of hypercytokinemia and systemic transformation of neutrophils, endothelial cells, mononuclear phagocytes, and mast cells into cellular effectors of inflammation, an inflammatory process devoid of protective significance occurs in many organs and tissues. Inflammation is accompanied by alteration of the structural and functional elements of effector organs.

Critical deficiency of effectors causes multiple systemic insufficiency.

Symptoms and signs of septic shock:

The development of a systemic inflammatory response is indicated by the presence of two or more of the following:

• Body temperature higher than 38 ^to C or below 36 ^to C.

• Respiratory rate above 20/minute. Respiratory alkalosis with carbon dioxide in the arterial blood below 32 mm Hg. Art.

• Tachycardia with heart rate greater than 90/minute.

• Neutrophilia with an increase in the content of polymorphonuclear leukocytes in the blood to a level above 12×10 ⁹ /l, or neutropenia when the content of neutrophils in the blood is below 4×10 ^9/ l.

• A shift in the leukocyte formula, in which stab neutrophils make up more than 10% of the total number of polymorphonuclear leukocytes.

Sepsis is evidenced by two or more signs of a systemic inflammatory response in the presence of pathogenic microorganisms in the internal environment confirmed by bacteriological and other studies.

Course of septic shock

In septic shock, hypercytokinemia increases the activity of nitric oxide synthetase in endothelial and other cells. As a result, the resistance of resistive vessels and venules decreases. A decrease in the tone of these microvessels reduces the total peripheral vascular resistance. Part of the cells of the body in septic shock suffers from ischemia due to disorders of the peripheral circulation. Peripheral circulatory disorders in sepsis and septic shock are consequences of systemic activation of endotheliocytes, polymorphonuclear neutrophils, and mononuclear phagocytes.

Inflammation of this genesis is purely pathological in nature, occurs in all organs and tissues. A critical drop in the number of structural and functional elements of most effector organs is the main link in the pathogenesis of the so-called multiple systemic failure.

According to traditional and correct ideas, sepsis and a systemic inflammatory reaction are caused by the pathogenic action of gram-negative microorganisms.

In the occurrence of a systemic pathological reaction to invasion into the internal environment and blood of Gram-negative microorganisms, the determining role is played by:

• Endotoxin (lipid A, lipopolysaccharide, LPS). This thermostable lipopolysaccharide makes up the outer coating of Gram-negative bacteria. Endotoxin, acting on neutrophils, causes the release of endogenous pyrogens by polymorphonuclear leukocytes.

• LPS-binding protein (LPBP), traces of which are determined in plasma under physiological conditions. This protein forms a molecular complex with endotoxin that circulates with the blood.

• Cell surface receptor of mononuclear phagocytes and endothelial cells. Its specific element is a molecular complex consisting of LPS and LPSBP (LPS-LPSSB).

There is currently an increasing incidence of sepsis due to invasion of the internal environment of gram-positive bacteria. The induction of sepsis by Gram-positive bacteria is usually not associated with their release of endotoxin. It is known that peptidoglycan precursors and other components of the walls of gram-positive bacteria cause the release of tumor necrosis factor-alpha and interleukin-1 by cells of the immune system. Peptidoglycan and other components of the walls of Gram-positive bacteria activate the complement system through an alternative pathway. Whole-body activation of the complement system causes systemic pathogenic inflammation and contributes to endotoxicosis in sepsis and the systemic inflammatory response.

It was previously thought that septic shock was always caused by endotoxin (lipopolysaccharide of bacterial origin) released by gram-negative bacteria. It is now generally accepted that less than 50% of cases of septic shock are caused by Gram-positive pathogens.

Disorders of the peripheral circulation in septic shock, adhesion of activated polymorphonuclear leukocytes to activated endotheliocytes – all this leads to the release of neutrophils into the interstitium and inflammatory alteration of cells and tissues. At the same time, endotoxin, tumor necrosis factor-alpha, and interleukin-1 increase the formation and release of tissue coagulation factor by endothelial cells. As a result, the mechanisms of external hemostasis are activated, which causes the deposition of fibrin and disseminated intravascular coagulation.

Arterial hypotension in septic shock is mainly a consequence of a decrease in total peripheral vascular resistance. Hypercytokinemia and an increase in the concentration of nitric oxide in the blood during septic shock causes the expansion of arterioles. At the same time, by means of tachycardia, the minute volume of blood circulation increases compensatory. Arterial hypotension in septic shock occurs despite a compensatory increase in cardiac output. Total pulmonary vascular resistance increases in septic shock, which can be partly attributed to the adhesion of activated neutrophils to activated pulmonary microvascular endotheliocytes.

The following main links in the pathogenesis of peripheral circulatory disorders in septic shock are distinguished:

1) an increase in the permeability of the microvascular wall;

2) an increase in the resistance of microvessels, which is enhanced by cell adhesion in their lumen;

3) low response of microvessels to vasodilating influences;

4) arteriolo-venular shunting;

5) drop in blood fluidity.

Hypovolemia is one of the factors of arterial hypotension in septic shock.

The following causes of hypovolemia (falling preload of the heart) in patients in a state of septic shock are distinguished:

1) dilatation of capacitive vessels;

2) loss of the liquid part of blood plasma in the interstitium due to pathological growth of capillary permeability.

It can be assumed that in the majority of patients in a state of septic shock, the drop in oxygen consumption by the body is mainly due to primary disorders of tissue respiration. In septic shock, mild lactic acidosis develops with normal oxygen tension in mixed venous blood.

Lactic acidosis in septic shock is thought to result from decreased pyruvate dehydrogenase activity and secondary accumulation of lactate, rather than a drop in peripheral blood flow.

Peripheral circulation disorders in sepsis are systemic in nature and develop with arterial normotension, which is supported by an increase in minute volume of blood circulation. Systemic microcirculation disorders manifest themselves as a decrease in pH in the gastric mucosa and a drop in blood hemoglobin oxygen saturation in the hepatic veins. Hypoergosis of the cells of the intestinal barrier, the action of immunosuppressive links in the pathogenesis of septic shock – all this reduces the protective potential of the intestinal wall, which is another cause of endotoxemia in septic shock.

Diagnosis of septic shock

• Septic shock – sepsis (systemic inflammatory response syndrome plus bacteremia) in combination with a decrease in blood pressure syst. less than 90 mm Hg Art. in the absence of visible reasons for arterial hypotension (dehydration, bleeding). The presence of signs of tissue hypoperfusion despite infusion therapy. Perfusion disorders include acidosis, oliguria, acute impairment of consciousness. In patients receiving inotropic drugs, perfusion disorders may persist in the absence of arterial hypotension.
• Refractory septic shock – septic shock lasting more than one hour, refractory to fluid therapy.

Treatment of septic shock:

1. Infusion therapy

• Catheterization of two veins.
• 300-500 ml IV crystalloid solution as a bolus followed by 500 ml IV crystalloid solution by drip over 15 minutes. Assess for venous hypertension and the presence of cardiac decompensation.
• In the presence of heart failure, catheterization is reasonable a. pulmonalis with a Swan-Ganz catheter to assess the volemic status: optimal PCWP = 12 mm Hg. Art. in the absence of AMI and 14-18 mm Hg. Art. in the presence of AMI;
• if after an infusion bolus the PCWP value exceeds 22 mmHg. Art., then progression of heart failure should be assumed and active infusion of crystalloids should be stopped.
• If, despite high left ventricular filling pressure values, arterial hypotension persists – dopamine 1-3-5 or more mcg/kg/min, dobutamine 5-20 mcg/kg/min.
• Calculated sodium bicarbonate to correct metabolic acidosis.

2. Therapy of hypoxemia/ARDS – oxygen therapy, mechanical ventilation using PEEP.

3. Therapy of reduced myocardial contractility – strophanthin K 0.5 mg 1-2 times a day IV in 10-20 ml of 5-20% glucose solution or physiological saline; digoxin 0.25 mg 3 times a day per os for 7-10 days, then 0.25-0.125 mg per day; dobutamine 5-20 mcg/kg/min IV.

4. DIC therapy

5. AKI therapy.

6. Empiric antibiotic therapy (taking into account the localization of the source of the septic process and the estimated range of possible microorganisms).

7. Surgical drainage of foci of infection.

8. Drugs, the effectiveness of which has not been confirmed:

• Naloxone.
• Corticosteroids.

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Issue	Title
Volume 18, No. 3 (2021)	Predictors of death in patients with refractory septic shock	annotation PDF (Rus) similar documents
A. A. Kochkin, M. Ya. Yadgarov, L. B. Berikashvili, S. N. Perekhodov, V. V. Likhvantsev
“… the provision fully applies to the situation of refractory septic shock in which to maintain … ”
Volume 14, No. 3 (2017)	EXPERIENCE WITH SELECTIVE LPS SORPTION IN COMPLEX THERAPY OF PATIENTS WITH GRAM-NEGATIVE SEPSIS	annotation PDF (Rus) similar documents
I. V. Bovkun, E. G. Gavrilova, D. V. Sokolov, I. V. Shlyk
“… treatment of patients with septic shock on a specific clinical example. Results: in a patient with…”
Volume 14, No. 5 (2017)	FIRST CLINICAL EXPERIENCE OF THE USE OF TOXIPAK LPS ADSORPTION COLUMNS IN THE TREATMENT OF PATIENTS WITH SEPSIS	annotation PDF (Rus) similar documents
L. L. Gendel, A. A. Sokolov, S. N. Gubanova, I. Yu. Adamova, P. A. Levashov
“… according to the SOFA scale) in patients with sepsis and septic shock . Conclusion: Toxipak columns are effective…”
Volume 18, No. 6 (2021)	Informational value of proadrenomedullin in the blood of patients with septic shock measured once upon admission to the ICU	annotation PDF (Rus) similar documents
V. A. Rudnov, A. V. Moldovanov, M. N. Astafieva, E. Yu. Perevalova, V. A. Bagin, S. M. Rozanova
“… . Hypovolemic and septic shock was compared by blood levels of PAM, procalcitonin (PCT) and lactate. Taking…”
Volume 18, No. 1 (2021)	Dual vasopressor therapy for septic shock	annotation PDF (Rus) similar documents
A. A. Kochkin, K. K. Kadantseva, V. V. Likhvantsev
“…additional vasopressor for septic shock . Methods. Conducted a single-center observational retrospective…”
Volume 19, No. 5 (2022)	Analysis of the effectiveness of the use of ascorbic acid, hydrocortisone and thiamine in the complex of adjuvant therapy of sepsis and septic shock	annotation PDF (Rus) similar documents
L. L. Plotkin, V. A. Artamonov
“… on clinical outcomes in patients with sepsis and septic shock . Materials and methods. Search…”
Volume 12, No. 2 (2015)	EARLY TARGETED THERAPY FOR SEPTIC SHOCK: A FINDING OUT OF A MULTI-CENTER RETROSPECTIVE ANALYSIS	annotation PDF (Rus) similar documents
L. L. Plotkin, I. Yu. Smolensky, N. N. Timchenko, I. P. Shapko, N. N. Safronova, A. G. Konashev, I. S. Edelstein
“… septic shock complicating the course of widespread peritonitis (abdominal sepsis). Treatment…”
RELATIONSHIP OF ENDOTHELIAL GLYCOCALYX WITH HEMODYNAMICS AND METABOLISM IN PATIENTS WITH SYPTIC SHOCK AND DURING CARDIAC SURGERY WITH CARBULATION	annotation PDF (Rus) similar documents
Ya. Yu. Ilyina, E. V. Fot, N. N. Izotova, A. A. Smetkin, D. A. Volkov, E. A. Yakovenko, T. V. Chernova, V. V. Kuzkov, M. Y. Kirov
“… for septic shock, cardiopulmonary bypass (EC), ischemia, reperfusion, and a number of others…”
Volume 16, No. 4 (2019)	Albumin solution in the modern concept of infusion therapy – the story continues?	annotation PDF (Rus) similar documents
V. V. Kulabukhov, A. A. Konkin, M. D. Utev
“… albumin in intensive care practice� Key words: hypoalbuminemia, hypovolemia, septic shock …”
Volume 19, No. 4 (2022)	Hemodynamic effects of levosimendan depending on the outcome of sepsis	annotation PDF (Rus) similar documents
I. N. Tyurin, D. N. Protsenko, I. A. Kozlov
“… septic shock who received levosimendan at a dose of 0.16 [0.15-0.17] mg on days 1-4 of intensive treatment…”
Volume 20, No. 2 (2023)	Predictors of poor outcome of severe infections in critically ill children	annotation PDF (Rus) similar documents
K. V. Pshenisnov, Yu. S. Aleksandrovich, K. Yu. Krasnoselsky, V. A. Kaziakhmedov, A. I. Konev, M. Yu. Kozubov
Vol 14, No 5 (2017)	THIAMINE DEFICIENCY AND ITS CORRECTION IN CRITICAL CONDITIONS	annotation PDF (Rus) similar documents
V. V. Lomivorotov, M. N. Deryagin, M. N. Abubakirov, E. V. Fominsky, V. A. Nepomnyashchikh
“… critical condition, pyruvate dehydrogenase, lactate, acidosis, septic shock cardiac failure For…”
Volume 18, No. 6 (2021)	Extended renal replacement therapy using membranes with increased sorption capacity in patients after neurosurgical interventions with septic shock	annotation PDF (Rus) similar documents
A. I. Burov, T. A. Abramov, N. V. Kurdyumova, A. V. Oshorov, D. S. Korotkov, N. S. Kostritsa, G. V. Danilov, Yu. V. Strunina, I. A. Savin
“… septic shock leads to secondary brain damage and an increase in neurological deficit…”
Vol 18, No 5 (2021)	Clinical and economic evaluation of the treatment of acute kidney injury in sepsis with long-term combined methods of renal replacement therapy	annotation PDF (Rus) similar documents
Yu. S. Polushin, R. O. Dreval, A. N. Zabotina
“… sepsis / septic shock . Methodology. The subject of the study is the pharmaco-economic indicators of direct … ”
0153	Myocardial biomarker NT-proBNP in patients with pulmonary sepsis and septic shock	annotation PDF (Rus) similar documents
I. N. Tyurin, D. N. Protsenko, I. A. Kozlov
“… or septic shock at the age of 54.5 ± 2.9 years. Mortality in the intensive care unit and intensive care…”
Vol 20, No 1 (2023 )	Clinical and economic evaluation of the use of selective sorption techniques for extracorporeal hemocorrection in ICU patients	annotation PDF (Rus) similar documents
Yu. S. Polushin, D. V. Sokolov, R. O. Dreval, A. N. Zabotina
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