Abstract
In 1872, Gross referred to shock as the “manifestation of the rude unhinging of the machinery of life.”1 We now know that shock, at its most fundamental level, represents the clinical syndrome arising as a result of inadequate tissue perfusion. The discrepancy between substrate delivery and the cellular substrate requirement leads to cellular metabolic dysfunction. Inadequate oxygen delivery is implicated as the principal defect in shock states. The clinical manifestations of shock are caused by end-organ dysfunction secondary to impaired perfusion and the body’s sympathetic and neuroendocrine response to an insufficient cellular supply/demand ratio for oxygen.
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References
Gross SG. A System of Surgery: Pathological, Diagnostic, Therapeutic, and Operative. Philadelphia: Lea and Febiger, 1872.
Rangel-Frausto MS, Pittet D, Costigan M, Hwang T, Davis CS, Wenzel RP. The natural history of the systemic inflammatory response syndrome. JAMA 1995;273:117–123.
Muckart DJJ, Bhagwanjee S. American College of Chest Physicians/Society of Critical Care Medicine consensus conference definitions of the systemic inflammatory response syndrome and allied disorders in relation to critically injured patients. Crit Care Med 1997;25:1789–1795.
American College of Chest Physicians—Society of Critical Care Medicine Consensus Conference. Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. Crit Care Med 1992;20:864–875.
Heckbert SR, Vedder NB, Hoffman W, et al. Outcome after hemorrhagic shock in trauma patients. J Trauma 1998;45:545–549.
Abramson D, Scalea TM, Hitchcock R, et al. Lactate clearance and survival following injury. J Trauma 1993;35:584–589.
Davis JW, Kaups KL, Parks SN. Base deficit is superior to pH in evaluating clearance of acidosis after traumatic shock. J Trauma 1998;1998:114–118.
McGee S, Abernethy WB, III, Simel DL. The rational clinical examination. Is this patient hypovolemic? JAMA 1999;281:1022–1029.
Dutton RP, Mackenzie CF, Scalea TM. Hypotensive resuscitation during active hemorrhage: impact on in-hospital mortality. J. Trauma 2002;52:1141–1146.
Merrer J, De Jonghe B, Golliot F, et al. Complications of femoral and subclavian venous catheterization in critically ill patients: a randomized controlled trial. JAMA 2001;286:700–707.
Dutkey PA, Stevens SL, Maull KI. Factors affecting rapid fluid resuscitation with large-bore introducer catheters. J Trauma 1989;29:856–860.
Junger WG, Coimbra R, Liu FC, et al. Hypertonic saline resuscitation: a tool to modulate immune function in trauma patients. Shock 1998;8:235–241.
Hartl R, Medary MB, Ruge M, Arfors KE, Ghahremani F, Ghajar J. Hypertonic/hyperoncotic saline attenuates microcirculatory disturbances after traumatic brain injury. J Trauma 1997;42(suppl 5):S41–S47.
Rizoli SB, Kapus A, Fan J, Li YH, Marshall JC, Rotstein OD. Immunomodulatory effects of hypertonic resuscitation on the development of lung inflammation following hemorrhagic shock. J Immunol 1998;161:6288–6296.
Wade CE, Dubick MA, Vassar MJ, Perry CA, Holcroft JW. Plasma dextran concentrations in trauma patients administered hypertonic saline-dextran 70. Clin Chem 1996;42:779–780.
Mattox KL, Maningas PA, Moore EE, et al. Prehospital hypertonic saline/dextran infusion for post-traumatic hypotension: the USA multicenter trial. Ann Surg 1991;213:482–491.
Maningas PA, Mattox KL, Pepe PE, Jones RL, Feliciano DV, Burch JM. Hypertonic saline-dextran solutions for the prehospital management of traumatic hypotension. Am J Surg 1989;157:528–534.
Cooper DJ, Myles PS, McDermott FT, et al. Prehospital hypertonic saline resuscitation of patients with hypotension and severe traumatic brain injury: a randomized controlled trial. JAMA 2004;291:1350–1357.
Vassar MJ, Fischer RP, O’Brien PE, et al. A multicenter trial for resuscitation of injured patients with 7.5% sodium chloride: the effect of added dextran 70. Arch Surg 1993;128:1003–1013.
Vassar MJ, Perry CA, Holcroft JW. Prehospital resuscitation of hypotensive trauma patients with 7.5% NaCl with added dextran: a controlled trial. J Trauma 1993;34:622–632.
Wade C. Efficacy of hypertonic saline (HSD) in patients with traumatic hypotension: meta analysis of individual patient data. Acta Anaesthesiol Scand Suppl 1997;110:77–79.
Wade CE, Kramer GC, Grady JJ, Fabian TC, Younes RN. Efficacy of hypertonic 7.5% saline and 6% dextran in treating trauma: a meta-analysis of controlled clinical studies. Surgery (St. Louis) 1997;122:609–616.
Wade CE, Grady JJ, Kramer GC, Younes RN, Gehlsen K, Holcroft JW. Individual patient cohort analysis of the efficacy of hypertonic saline/dextran in patients with traumatic brain injury and hypotension. J Trauma 1997;42:S61–S65.
Alderson P, Bunn F, Lefebvre C, et al. Human albumin solution for resuscitation and volume expansion in critically ill patients. Cochrane Database Syst Rev 2002 (1): CD001208.
Wilkes MM, Navickis RJ. Patient survival after human albumin administration. A meta-analysis of randomized, controlled trials. Ann Intern Med 2001;135:149–164.
Fleck A, Raines G, Hawker F, et al. Increased vascular permeability: a major cause of hypoalbuminemia in disease and injury. Lancet 1985;1:781–784.
Moon MR, Lucas CE, Ledgerwood AM, Kosinski JP. Free water clearance after supplemental albumin resuscitation for shock. Circ Shock 1989;28:1–8.
Strauss RG, Pennell BJ, Stump DC. A randomized, blinded trial comparing the hemostatic effects of pentastarch versus hetastarch. Transfusion 2002;42:27–36.
Langeron O, Doelberg M, Ang ET, Bonnet F, Capdevila X, Coriat P. Voluven, a lower substituted novel hydroxyethyl starch (HES 130/0.4), causes fewer effects on coagulation in major orthopedic surgery than HES 200/0.5. Anesth Analg 2001;92:855–862.
Nagy KK, Davis J, Duda J, Fildes J, Roberts R, Barrett J. A comparison of pentastarch and lactated Ringer’s solution in the resuscitation of patients with hemorrhagic shock. Circ Shock 1993;40:289–294.
Younes RN, Yin KC, Amino CJ, Itinoshe M, Rocha e Silva M, Birolini D. Use of pentastarch solution in the treatment of patients with hemorrhagic hypovolemia: randomized phase II study in the emergency room. World J Surg 1998;22:2–5.
Schortgen F, Lacherade JC, Bruneel F, et al. Effects of hydroxyethyl starch and gelatin on renal function in severe sepsis: a multicentre randomised study. Lancet 2001;357:911–916.
Moore FA, Moore EE, Sauaia A. Blood transfusion: an independent risk factor for postinjury multiple organ failure. Arch Surg 1997;132:620–625.
Patrick DA, Moore EE, Barnett CC, Silliman CC. Human polymerized hemoglobin as a blood substitute avoids transfusion induced neutrophil priming. Surg Forum 1996;47:36–38.
Hebert PC, Wells G, Blajchman MA, et al. A multicenter, randomized controlled clinical trial of transfusion requirements in critical care. N Engl J Med 1999;340:409–417.
Griswold RA, Ortner AB. The use of autotransfusion in surgery of the serous cavities. Surg Gynecol Obstet 1943;77:167.
Jacobs LM, Hsieh JW. A clinical review of autotransfusion and its role in trauma. JAMA 1984;251:3283.
Tiimberlake GA, McSwain NE. Autotransfusion of blood contaminated by enteric contents: a potentially life saving measure in the massively hemorrhaging trauma patient. J Trauma 1988;28:855–857.
Ozmen V, McSwain NE, Nichols RL, Smith J, Flint LM. Autotransfusion of potentially culture-positive blood (CPB) in abdominal trauma: preliminary data from a prospective study. J Trauma 1992;32:36–39.
Jurkovich GJ, Moore EE, Mediana G. Autotransfusion in trauma: a pragmatic analysis. Am J Surg 1984;148:782.
Smith LA, Barker DE, Burns RP. Autotransfusion utilization in abdominal trauma. Am Surg 1997;63:47–49.
Huth JF, Maier RV, Pavlin EG, et al. Utilization of blood recycling in nonelective surgery. Arch Surg 1983;118:626–629.
Sloan EP, Koenigsberg M, Gens D, et al. Diaspirin cross-linked hemoglobin (DCLHb) in the treatment of severe traumatic hemorrhagic shock: a randomized controlled efficacy trial. JAMA 1999;282:1857–1864.
Kerner T, Ahlers O, Veit S, Riou B, Saunders M, Pison U. DCLHb for trauma patients with severe hemorrhagic shock: the European “On-Scene” multicenter study. Intensive Care Med 2003;29:378–385.
Bloomfield EL, Rady MY, Esfandiari S. A prospective trial of diaspirin cross-linked hemoglobin solution in patients after elective repair of abdominal aortic aneurysm. Mil Med 2004;169:546–550.
Schubert A, O’Hara JF Jr, Przybelski RJ, et al. Effect of diaspirin cross-linked hemoglobin (DCLHb HemAssist) during high blood loss surgery on selected indices of organ function. Artif Cells Blood Substit Immobil Biotechnol 2002;30:259–283.
Lamy ML, Daily EK, Brichant JF, et al. Randomized trial of diaspirin cross-linked hemoglobin solution as an alternative to blood transfusion after cardiac surgery. The DCLHb Cardiac Surgery Trial Collaborative Group. Anesthesiology 2000;92:646–656.
Gould SA, Moore EE, Moore FA, et al. Clinical utility of human polymerized hemoglobin as a blood substitute after acute trauma and urgent surgery. J Trauma 1997;43:325–332.
Gould SA, Moss GS. Clinical development of human polymerized hemoglobin as a blood substitute. World J Surg 1996;20:1200–1207.
Gould SA, Moore EE, Hoyt DB, et al. The first randomized trial of human polymerized hemoglobin as a blood substitute in acute trauma and emergent surgery. J Am Coll Surg 1998;187:113–122.
Broos PL, Stappaerts KH, Luite EJ, Gruwez JA. The importance of early internal fixation in multiply injured patients to prevent late deaths and sepsis. Injury 1987;18:235–237.
Lozman J, Deno DC, Feustel PJ, et al. Pulmonary and cardiovascular consequences of immediate fixation or conservative management of long-bone fractures. Arch Surg 1986;121:992–999.
Kinch JW, Ryan TJ. Right ventricular infarction. N Engl J Med 1994;330:1211–1217.
Alonso Dr, Scheidt S, Post M, Killip T. Pathophysiology of cardiogenic shock: quantification of myocardial necrosis, clinical, pathologic and electrocardiographic correlations. Circulation 1973;48:588–596.
Hochman JS, Buller CE, Sleeper LA, et al. Cardiogenic shock complicating acute myocardial infarction—etiologies, management and outcome: a report from the SHOCK Trial Registry. SHould we emergently revascularize Occluded Coronaries for cardiogenic shocK? J Am Coll Cardiol 2000;36(3 suppl A):1063–1070.
Califf RM, Bengston JR. Cardiogenic shock. N Engl J Med 1994;330:1724–1730.
Moscucci M, Bates ER. Cardiogenic shock. Cardiol Clin 1995;13:391–406.
Becker LC, Fortuin NJ, Pitt B. Effect of ischemia and antianginal drugs on the distribution of radioactive microspheres in the canine left ventricle. Circ Res 1971;28:263–269.
Freed PS, Wasfre T, Zado B, Kentrowitz A. Intraaortic balloon pumping for prolonged circulatory support. Am J Cardiol 1988;61:554.
Muller H, Ayres SM, Giannelli S, et al. Effect of isoproterenol, l-norepinephrine, and intraaortic counterpulsation on hemodynamics and myocardial metabolism in shock following acute myocardial infarction. Circulation 1972;45:335.
Bardet J, Mesquet C, Kahn JC, Gourgon R, Bourdarics JP. Clinical and hemodynamic results of intraaortic balloon counterpulsation and surgery for cardiogenic shock. Am J Heart 1977;93:280.
Sanborn TA, Sleeper LA, Bates ER, et al. Impact of thrombolysis, intra-aortic balloon pump counterpulsation, and their combination in cardiogenic shock complicating acute myocardial infarction: a report from the SHOCK Trial Registry. SHould we emergently revascularize Occluded Coronaries for cardiogenic shocK? J Am Coll Cardiol 2000;36(3 suppl A):1123–1129.
Hochman JS, Sleeper LA, White HD, et al. One-year survival following early revascularization for cardiogenic shock. JAMA 2001;285:190–192.
Parker MM, Shelhamer JH, Bacharach SL, et al. Profound but reversible myocardial depression in patients with septic shock. Ann Intern Med 1984;100:483–490.
Silverman HJ, Penaranda R, Orens JB, Lee NH. Impaired beta-adrenergic receptor stimulation of cyclic adenosine monophosphate in human septic shock: association with myocardial hyporesponsiveness to catecholamines. Crit Care Med 1993;21:31–39.
Jafri SM, Lavine S, Field BE, Bahorozian MT, Carlson RW. Left ventricular diastolic function in sepsis. Crit Care Med 1990;18:709–713.
Parker MM. Pathophysiology of cardiovascular dysfunction in septic shock. New Horizons 1998;6:130–138.
Garrison RN, Cryer HM. Role of the microcirculation to skeletal muscle during shock. Prospect Shock Res 1989;1:43–52.
Avontuur JAM, Nolthenius T, van Bodegom JW, Bruining HA. Prolonged inhibition of nitric oxide synthesis in severe septic shock: a clinical study. Crit Care Med 1998;26:660–667.
Palmer RMJ. The discovery of nitric oxide in the vessel wall: a unifying concept in the pathogenesis of sepsis. Arch Surg 1993;128:396–401.
Bakker J, Grover R, McLuckie A, et al. Administration of the nitric oxide synthase inhibitor NG-methyl-l-arginine hydrochloride (546C88) by intravenous infusion for up to 72h can promote the resolution of shock in patients with severe sepsis: results of a randomized, double-blind, placebo-controlled multicenter study (study no. 144-002). Crit Care Med 2004;32:1–12.
Lopez A, Lorente JA, Steingrub J, et al. Multiple-center, randomized, placebo-controlled, double-blind study of the nitric oxide synthase inhibitor 546C88: effect on survival in patients with septic shock. Crit Care Med 2004;32:21–30.
Hinshaw LB. Sepsis/septic shock: participation of the microcirculation: an abbreviated review. Crit Care Med 1996;24:1072–1078.
Leibovici L, Drucker M, Konigsberger H, et al. Septic shock in bacteremic patients: risk factors, features and prognosis. Scand J Infect Dis 1997;29:71–75.
Piepmeier JM, Kenneth LB, John LG. Cardiovascular instability following acute cervical spinal cord trauma. Cent Nerv Syst Trauma 1985;2:153.
Lehmann KG, Lane JG, Piepmeier JM, Batsford WP. Cardiovascular abnormalities accompanying acute spinal cord injury in humans: incidence, time course and severity. J Am Coll Cardiol 1987;10:46–52.
Levi L, Wolf A, Belzberg H. Hemodynamic parameters in patients with acute cervical cord trauma: description, intervention, and prediction of outcome. Neurosurgery (Baltim) 1993;33:1007–1017.
Annane D, Sebille V, Charpentier C, et al. Effect of treatment with low doses of hydrocortisone and fludrocortisone on mortality in patients with septic shock. JAMA 2002;288:862–871.
Annane D, Sebille V, Troche G, Raphael JC, Gajdos P, Bellissant E. A 3-level prognostic classification in septic shock based on Cortisol levels and Cortisol response to corticotropin. JAMA 2000;283:1038–1045.
Annane D, Bellissant E, Bollaert PE, Briegel J, Keh D, Kupfer Y. Corticosteroids for severe sepsis and septic shock: a systematic review and meta-analysis. BMJ 2004;329:480.
Rhodes A, Cusack RJ, Newman PJ, Grounds RM, Bennett ED. A randomised, controlled trial of the pulmonary artery catheter in critically ill patients. Intensive Care Med 2002;28:256–264.
Richard C, Warszawski J, Anguel N, et al. Early use of the pulmonary artery catheter and outcomes in patients with shock and acute respiratory distress syndrome: a randomized controlled trial. JAMA 2003;290:2713–2720.
Esposito TJ, Jurkovich GJ, Rice CL, Maier RV, Copass MK, Ashbaugh DG. Reappraisal of emergency room thoracotomy in a changing environment. J Trauma 1991;31:881–885.
Branney SW, Moore EE, Feldhaus KM, Wolfe RE. Critical analysis of two decades of experience with postinjury emergency department thoracotomy in a regional trauma center. J Trauma 1998;45:87–94.
Lorenz HP, Steinmetz B, Lieberman J, Schecoter WP, Macho JR. Emergency thoracotomy: survival correlates with physiologic status. J Trauma 1992;32:780–785.
Ivatury RR, Kazigo J, Rohman M, Gaudino J, Simon R, Stahl WM. “Directed” emergency room thoracotomy: a prognostic prerequisite for survival. J Trauma 1991;31:1076–1081.
Hopson LR, Hirsh E, Delgado J, Domeier RM, McSwain NE, Krohmer J. Guidelines for withholding or termination of resuscitation in prehospital traumatic cardiopulmonary arrest: joint position statement of the National Association of EMS Physicians and the American College of Surgeons Committee on Trauma. J Am Coll Surg 2003;196:106–112.
Stevens PE, Gwyther SJ, Hanson ME. Noninvasive monitoring of renal blood flow characteristics during acute renal failure in man. Intensive Care Med 1990;16:153–158.
McDonald RH, Goldberg LI, McNay JL, et al. Effects of dopamine in man: augmentation of sodium excretion, glomerular filtration rate, and renal plasma flow. J Clin Invest 1973;45:733–742.
Hollenberg SM, Ahrens TS, Annane D, et al. Practice parameters for hemodynamic support of sepsis in adult patients: 2004 update. Crit Care Med. 2004;32:1928–1948.
Dunser MW, Mayr AJ, Ulmer H, et al. Arginine vasopressin in advanced vasodilatory shock: a prospective, randomized, controlled study. Circulation 2003;107:2313–2319.
Patel BM, Chittock DR, Russell JA, Walley KR. Beneficial effects of short-term vasopressin infusion during severe septic shock. Anesthesiology 2002;96:576–582.
Goris RJA. Prevention of ARDS and MOF by prophylactic mechanical ventilation and early fracture stabilization. Prog Clin Biol Res 1987;236B:163.
Gregory JS, Flancbaum L, Townsend MC, Cloutier CT, Jonasson O. Incidence and timing of hypothermia in trauma patients undergoing operations. J Trauma 1991;31:795–798.
Paton BC. Cardiac function during accidental hypothermia. In: Pozos RE, Wittmer LE, eds. The Nature and Treatment of Hypothermia. Minneapolis: University of Minnesota Press, 1983:133–142.
Gubler KD, Gentilello LM, Hassantash SA, Maier RV. The impact of hypothermia on dilutional coagulopathy. J Trauma 1994;36:847–851.
Gentilello LM, Cobean RA, Offner PJ, Soderberg RW, Jurkovich GJ. Continuous arteriovenous rewarming: rapid reversal of hypothermia in critically ill trauma patients. J Trauma 1992;32:316–327.
Gentilello LM, Jurkovich GJ, Stark MS, Hassantash SA, O’Keefe GE. Is hypothermia in the victim of major trauma protective or harmful? A randomized, prospective study. Ann Surg 1997;226:439–447.
Ivatury RR, Diebel L, Porter JM, Simon RJ. Intra-abdominal hypertension and the abdominal compartment syndrome. Surg Clin North Am 1997;77:783–800.
Cullen DJ, Coyle JP, Teplick R, Long MC. Cardiovascular, pulmonary, and renal effects of massively increased intraabdominal pressure in critically ill patients. Crit Care Med 1989;17:118–121.
Meldrum DR, Moore FA, Moore EE, Haenel JB, Cosgriff N, Burch JM. Cardiopulmonary hazards of perihepatic packing for major liver injuries. Am J Surg 1995;170:537–542.
Bloomfield GL, Ridings PC, Blocher CR, Marmarou A, Sugerman HJ. A proposed relationship between increased intraabdominal, intrathoracic and intracranial pressure. Crit Care Med 1997;25:496–503.
Bloomfield GL, Ridings PC, Blocher CR, Marmarou A, Sugerman H. Effects of increased intra-abdominal pressure upon intracranial and cerebral perfusion pressure before and after volume expansion. J Trauma 1996;40:936–943.
Caldwell CB, Ricotta JJ. Evaluation of intra-abdominal pressure and renal hemodynamics. Curr Surg 1986;43:495–498.
Bongard F, Pianim N, Dubecz S, Klein SR. Adverse consequences of increased intraabdominal pressure on bowel tissue oxygen. J Trauma 1995;39:519–525.
Kron IL, Harman PK, Nolan SP. The measurement of intraabdominal pressure as a criterion for abdominal re-exploration. Ann Surg 1984;199:28–30.
Kirkpatrick AW, Brenneman FD, McLean RF, Rapanos T, Boulanger BR. Is clinical examination an accurate indicator of raised intra-abdominal pressure in critically injured patients? Can J Surg 2000;43:207–211.
Iberti TJ, Kelly KM, Gentili DR, Hirsch S, Benjamin E. A simple technique to accurately determine intra-abdominal pressure. Crit Care Med 1987;15:1140–1142.
Burch JM, Moore EE, Moore FA, Franciose R. The abdominal compartment syndrome. Surg Clin North Am 1996;76:833–842.
Meldrum DR, Moore FA, Moore EE, Franciose RJ, Sauia A, Burch JM. Prospective characterization and selective management of the abdominal compartment syndrome. Am J Surg 1997;174:667–672.
Schwaitzberg SD, Bergman KS, Harris BH. A pediatric trauma model of continuous hemorrhage. J Pediatr Surg 1988;23:605–609.
Rackow EC, Falk JL, Fein LA, et al. Fluid resuscitation in circulatory shock: a comparison of albumin, hetastarch and saline solutions in patients with hypovolemic and septic shock. Crit Care Med 1983;11:839–850.
American College of Surgeons. Shock. In: Advanced Trauma Life Support Manual. Chicago: American College of Surgeons, 1997:87–107.
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Nathens, A.B., Maier, R.V. (2008). Shock and Resuscitation. In: Norton, J.A., et al. Surgery. Springer, New York, NY. https://doi.org/10.1007/978-0-387-68113-9_16
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