Skip to main content
SpringerLink
Log in
Book cover

Operative Techniques and Recent Advances in Acute Care and Emergency Surgery pp 43–54Cite as

Shock States in Acute Care Surgery

  • Chapter

  • 1658 Accesses

Abstract

Shock is a condition of insufficient oxygen delivery to the tissues to meet metabolic demands. Shock is not synonymous with hypotension albeit hypotension is almost always associated with shock. Arterial blood pressure, therefore, is not sufficient to diagnose shock. Rather the diagnosis relies on the presence of tissue hypoperfusion (increased arterial blood lactates). With shock, the cellular metabolism is shifted from aerobic to anaerobic. The metabolic consequence of prolonged shock is cellular energy depletion with calcium entry into the cytosol, increased production of reactive oxygen species (ROS), altered membrane permeability and swelling. This causes cellular membrane rupture and death. Subsequent reperfusion of damaged cells contributes to increased ROS production, endothelial barrier disruption with interstitial oedema formation. Ischaemia- reperfusion injury also causes a diffuse inflammatory response with activation of polimorphonuclear neutrophils (PMNs) and production of diffuse organ damage.

Haemorrhagic shock is by far the prevalent form of shock in the surgical care setting. Hypovolemia decreases intravascular volume, and anaemia reduces the haemoglobin content so that oxygen supply is severely diminished. The decrease of venous return by reduction of the stressed volume is the main mechanism of hypovolemia in haemorrhagic shock. However, up to 750 mL of blood can be lost without appreciable effects due to the physiological reserve.

This is a preview of subscription content, log in via an institution.

Chapter
USD   29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD   189.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Hardcover Book
USD   249.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Learn about institutional subscriptions

References

  1. Baron BJ, Scalea TM. Acute blood loss. Emerg Med Clin North Am. 1996;14:35–55.

    CAS  PubMed  Google Scholar 

  2. World Health Organization. Injury chart book. A graphical overview of the global burden of injuries. Department of injuries and violence prevention. Noncommunicable diseases and Mental Health Cluster. Geneva: World Health Organization; 2002. http://www.who.int/violence _injury_prevention/pubblication/other_injury/chart/en/.

    Google Scholar 

  3. Chrousos GP. The hypothalamic-pituitary-adrenal-axis and immune mediated inflammation. N Engl J Med. 1995;332:1351–62.

    CAS  PubMed  Google Scholar 

  4. Rothe CF. Reflex control of veins and vascular capacitance. Physiol Rev. 1983;63(4):1281–95.

    CAS  PubMed  Google Scholar 

  5. Guyton AC, Jones CE, Coleman TG. Circulatory physiology: cardiac output and its regulation. In: Guyton AC, editor. Philadelphia: WB Saunders; 1973.

    Google Scholar 

  6. Guyton AC, Lindsey AW, Kaufman BN. Effect of mean circulatory filling pressure and other peripheral circulatory factors on cardiac output. Am J Physiol. 1955;180:659–77.

    Google Scholar 

  7. Rothe CF, Drees JA. Vascular capacitance and fluid shifts in dogs during prolonged hemorrhagic hypotension. Circ Res. 1976;38(5):347–56.

    CAS  PubMed  Google Scholar 

  8. Rothe CF, Johns BL, Bennett TD. Vascular capacitance of dog intestine using mean transit time of indicator. Am J Physiol. 1978;234(1):H7–H13.

    CAS  PubMed  Google Scholar 

  9. Crowell JW, Smith EE. Oxygen deficit and irreversible hemorrhagic shock. Am J Physiol. 1984;206:313–6.

    Google Scholar 

  10. Dunham CM, Siegel JH, Weireter L, Fabian M, Goodarzi S, Guadalupi P, Gettings L, Linberg SE, Vary TC. Oxygen debt and metabolic academia as quantitative predictors of mortality and the severity of the ischemic insult in hemorrhagic shock. Crit Care Med. 1991;19:231–43.

    CAS  PubMed  Google Scholar 

  11. Rixen D, Raum M, Holzgraefe B, Sauerland S, Nagelshmidt M, Neugebauer EA. Shock and trauma study group. A pig hemorrhagic shock model: oxygen debt and metabolic academia as indicators of severity. Shock. 2001;16:239–44.

    CAS  PubMed  Google Scholar 

  12. Rixen D, Siegel JH. Bench-to-bedside review: oxygen debt and its metabolic correlates as quantifiers of the severity of hemorrhagic and post-traumatic shock. Crit Care. 2005;9:441–53.

    PubMed  PubMed Central  Google Scholar 

  13. Rixen D, Raum M, Bouillon B, Lefering R, Neugebauer E. Arbeits-gemeinschaft ‘Polytrauma’ of the Deutschen Gesellschaft Fur Unhallchirurgie: base deficit development and its prognostic significance in posttrauma critical illness: an analysis by trauma registry of the Deutsche Gesellschaft fur Unfallechirurgie. Shock. 2001;15:83–9.

    CAS  PubMed  Google Scholar 

  14. Weil MH, Henning RJ. New concepts in the diagnosis and fluid treatment of circulatory shock. Thirteenth annual Becton, Dickinson and Company Oscar Schwidetsky Memorial Lecture. Anesth Analg. 1979;58(2):124–31.

    CAS  PubMed  Google Scholar 

  15. Magder SA, Georgiadis G, Cheong T. Respiratory variations in right atrial pressure predict the response to fluid challenge. J Crit Care. 1992;7(2):76–85.

    Google Scholar 

  16. Feissel M, Michard F, Faller JP, Teboul JL. The respiratory variations in inferior vena cava diameter as a guide to fluid therapy. Intensive Care Med. 2004;30(9):1834–7.

    PubMed  Google Scholar 

  17. Barbier C, Loubiere Y, Schmit C, Hayon J, Ricome JL, Jardin F, Veillard-Baron A. Respiratory changes in inferior vena cava diameter are helpful in predicting fluid responsiveness in ventilated septic patients. Intensive Care Med. 2004;30(9):1740–6.

    PubMed  Google Scholar 

  18. Appleton C, Olajos M, Morkin E, Goldman S. Alpha-1 adrenergic control of the venous circulation in intact dogs. J Pharmacol Exp Ther. 1985;233(3):729–34.

    CAS  PubMed  Google Scholar 

  19. Calvin JE, Quinn B. Right ventricular pressure overload during acute lung injury: cardiac mechanics in the pathophysiology of right ventricular systolic dysfunction. J Crit Care. 1989;4(4):251–65.

    Google Scholar 

  20. Calvin JE. Right ventricular afterload mismatch during acute pulmonary hypertension and its treatment with dobutamine: a pressure segment length analysis in a canine model. J Crit Care. 1989;4(4):239–50.

    CAS  Google Scholar 

  21. Chien S, Dellenback RJ, Usami S, Treitel K, Chang C, Gregersen MI. Blood volume and its distribution in endotoxin shock. Am J Physiol. 1966;210(6):1411–8.

    CAS  PubMed  Google Scholar 

  22. Lang CH, Bagby GJ, Ferguson JL, Spitzer JJ. Cardiac output and redistribution of organ blood flow in hypermetabolic sepsis. Am J Physiol. 1984;246:R331–7.

    CAS  PubMed  Google Scholar 

  23. MacLean MR, Mulligan WG, MacLean APH, Duff JH. Patterns of septic shock in man-a detailed study of 56 patients. Ann Surg. 1967;166:543–62.

    CAS  PubMed  PubMed Central  Google Scholar 

  24. Parker MM, Parrillo JE. Septic shock: hemodynamic and pathogenesis. JAMA. 1983;250(24):3324–7.

    CAS  PubMed  Google Scholar 

  25. Magder SA, Quinn R. Endotoxin and the mechanical properties of the canine peripheral circulation. J Crit Care. 1991;6(2):81–8.

    Google Scholar 

  26. Desjars P, Pinaud M, Bugnon D, Tasseau F. Norepinephrine therapy has no deleterious renal effects in human septic shock. Crit Care Med. 1989;17(5):426–9.

    CAS  PubMed  Google Scholar 

  27. Cournard A, Motley HL, Werko L. Physiological studies of the effect of intermittent positive pressure breathing on cardiac output in man. Am J Physiol. 1948;152:169–74.

    Google Scholar 

  28. Scharf SM, Brown R, Tow DE, Parisi AF. Cardiac effects of increasing lung volume and decreasing pleural pressure. J Appl Physiol Respir Environ Exerc Physiol. 1979;47:253–62.

    Google Scholar 

  29. Scharf SM, Caldini P, Ingram RH. Cardiovascular effects of increasing airway pressure in the dog. Am J Physiol. 1977;232(1):H35–43.

    CAS  PubMed  Google Scholar 

  30. Fessler HE, Brower RG, Wise RA, Permutt S. Effects of positive end-expiratory pressure on the gradient for venous return. Am Rev Respir Dis. 1991;143:19–24.

    CAS  PubMed  Google Scholar 

  31. Chambers DE, Parks DA, Patterson G, Roy R, McCord JM, Yoshida S, Parmley LF, Downey JM. Xanthine-Oxidase as a source of free radical damage in myocardial ischemia. J Mol Cell Cardiol. 1985;17:145–52.

    CAS  PubMed  Google Scholar 

  32. Becker LB. New concepts in reactive oxygen species and cardiovascular reperfusion physiology. Cardiovasc Res. 2004;61:461–70.

    CAS  PubMed  Google Scholar 

  33. Maxwell SR, Lip GY. Reperfusion injury: a review of the pathophysiology, clinical manifestation and therapeutic optioins. Int J Cardiol. 1997;58:95–117.

    CAS  PubMed  Google Scholar 

  34. McCully JD, Wakiyama H, Hsieh YJ, Jones M, Levitsky S. Differential contribution of necrosis and apoptosis in myocardial ischemia-reperfusion injury. Am J Physiol Heart Circ Physiol. 2004;286:1923–35.

    Google Scholar 

  35. Seal JB, Gewertz BL. Vascular dysfunction in ischemia reperfusion injury. Ann Vasc Surg. 2005;19:572–84.

    PubMed  Google Scholar 

  36. Ernster L. Biochemistry of reoxygenation injury. Crit Care Med. 1988;16:947–53.

    CAS  PubMed  Google Scholar 

  37. Mentzer RM, Lasley RD, Jessel A, Karmazyn M. Intracellular sodium hydrogen exchange inhibition and clinical myocardial protection. Ann Thorac Surg. 2003;75:S700–8.

    PubMed  Google Scholar 

  38. Barry MC, Wang JH, Kelly CJ, Sheenan SJ, Redmond HP, Bouchier-Hayes DJ. Plasma factors augment neutrophil and endothelial activation during aortic surgery. Eur J Vasc Endovasc Surg. 1997;13:381–7.

    CAS  PubMed  Google Scholar 

  39. Barry MC, Kelly C, Burke P, Sheehan S, Redmond HP, Bouchier-Hayes D. Immunological and physiological responses to aortic surgery: effect of reperfusion on neutrophil and monocyte activation and pulmonary function. Br J Surg. 1997;84:513–9.

    CAS  PubMed  Google Scholar 

  40. Hill JH, Ward PA. The phlogistic role of C3 leukotactic fragment in myocardial infarct in rats. J Exp Med. 1971;133:855–900.

    Google Scholar 

  41. Boyle EM, Pohlman TH, Cornejo CJ, Verrier ED. Ischemia-reperfusion injury. Ann Thorac Surg. 1997;64:S24–30.

    Google Scholar 

  42. Menger MD, Rucker M, Vollmar B. Capillary dysfunction in striated muscle ischemia/reperfusion on the mechanisms of capillary “no-reflow”. Shock. 1997;8:2–7.

    CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Anesthesia and Intensive Care (1st Department), ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy

    Sergio Arlati

Authors
  1. Sergio Arlati
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Sergio Arlati .

Editor information

Editors and Affiliations

  1. Dipartimento di Emergenza Urgenza, ASST Grande Ospedale Metropolitano Niguarda, Milan, Milano, Italy

    Paolo Aseni

  2. School of Medicine, University of Milano-Bicocca, Niguarda Hospital, Milan, Milano, Italy

    Luciano De Carlis

  3. Department of Cardiac Surgery, IRCCS MultiMedica, Milan, Milano, Italy

    Alessandro Mazzola

  4. Department of Cardiac Surgery, IRCCS Fondazione Policlinico San Matteo, Pavia, Italy

    Antonino M. Grande

Rights and permissions

Reprints and permissions

Copyright information

© 2019 Springer International Publishing AG, part of Springer Nature

About this chapter

Cite this chapter

Arlati, S. (2019). Shock States in Acute Care Surgery. In: Aseni, P., De Carlis, L., Mazzola, A., Grande, A.M. (eds) Operative Techniques and Recent Advances in Acute Care and Emergency Surgery. Springer, Cham. https://doi.org/10.1007/978-3-319-95114-0_3

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-95114-0_3

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-95113-3

  • Online ISBN: 978-3-319-95114-0

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation