Septic Shock: Cardiovascular Function and Management

  • M. M. Parker
Part of the Update in Intensive Care and Emergency Medicine book series (UICM, volume 25)


Septic shock is one of the most common causes of morbidity and mortality in patients in intensive care units. Despite the great advances in antibiotic therapy over the past two decades, the mortality from septic shock has not decreased appreciably. Our understanding of the pathophysiology of sepsis and septic shock has evolved rapidly over this time. As we understand the pathophysiology of the syndrome better, our treatment of patients will become more focussed and, we hope, more effective. The acute event that brings the patient to the intensive care unit is often the development of shock. This article will discuss the changes in cardiovascular function that occur in the patient with septic shock and the current approaches to hemodynamic management.


Septic Shock Cardiac Index Oxygen Delivery Systemic Vascular Resistance Pulmonary Artery Occlusion Pressure 
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  1. 1.
    Parker MM, Fink MP (1992) Septic shock. J Intensive Care Med 7:90–100.Google Scholar
  2. 2.
    Parker MM, Shelhamer JH, Natanson C, Ailing DW, Parrillo JE (1987) Serial cardiovascular variables in survivors and nonsurvivors of human septic shock: Heart rate as an early predictor of prognosis. Crit Care Med 15:923–929.PubMedCrossRefGoogle Scholar
  3. 3.
    Groeneveld ABJ, Nauta JJP, Thijs LG (1988) Peripheral vascular resistance in septic shock: its relation to outcome. Intensive Care Med 14:141–147.PubMedCrossRefGoogle Scholar
  4. 4.
    Tuchschmidt J, Oblitas D, Fried JC (1991) Oxygen consumption in sepsis and septic shock. Crit Care Med 19:664–671.PubMedCrossRefGoogle Scholar
  5. 5.
    Pollack MM, Fields AI, Ruttimann UE (1984) Sequential cardiopulmonary variables of infants and children in septic shock. Crit Care Med 12:554–559.PubMedCrossRefGoogle Scholar
  6. 6.
    Seear M, Wensley D, MacNab A (1993) Oxygen consumption-oxygen delivery relationship in children. J Pediatr 123:208–214.PubMedCrossRefGoogle Scholar
  7. 7.
    Parker MM, Shelhamer JH, Bacharach SL, et al (1984) Profound but reversible myocardial depression in patients with septic shock. Ann Intern Med 100:483–490.PubMedGoogle Scholar
  8. 8.
    Parker MM, McCarthy KE, Ognibene FP, Parrillo JE (1990) Right ventricular dysfunction and dilatation, similar to left ventricular changes, characterize the cardiac depression of septic shock in humans. Chest 97:126–131.PubMedCrossRefGoogle Scholar
  9. 9.
    Raper R, Sibbald WJ, Driedger AA, Gerow K (1989) Relative myocardial depression in normotensive sepsis. J Crit Care 4:9–18.CrossRefGoogle Scholar
  10. 10.
    Cunnion RE, Schaer GL, Parker MM, Natanson C, Parrillo JE (1986) Circulation 73:637–644.PubMedCrossRefGoogle Scholar
  11. 11.
    Parrillo JE, Burch C, Shelhamer JH, Parker MM, Natanson C, Schuette W (1985) A circulating myocardial depressant substance in humans with septic shock. J Clin Invest 76:1539–1553.PubMedCrossRefGoogle Scholar
  12. 12.
    Danner RL, Elin RJ, Hosseini JM, Wesley RA, Reilly JM, Parrillo JE (1991) Endotoxemia in human septic shock. Chest 99:169–175.PubMedCrossRefGoogle Scholar
  13. 13.
    Suffredini AF, Fromm RE, Parker MM, et al (1989) The cardiovascular response of normal humans to the administration of endotoxin. N Engl J Med 321:280–287.PubMedCrossRefGoogle Scholar
  14. 14.
    Finkel MS, Oddis CV, Jacob TD, Watkins SC, Hattler BG, Simmons RL (1992) Negative inotropic effects of cytokines on the heart mediated by nitric oxide. Science 257:387–389.PubMedCrossRefGoogle Scholar
  15. 15.
    Lorente J A, Landin L, Renes E, et al (1993) Role of nitric oxide in the hemodynamic changes of sepsis. Crit Care Med 21:759–767.PubMedCrossRefGoogle Scholar
  16. 16.
    Carcillo J A, Davis AL, Zaritsky A (1991) Role of early fluid resuscitation in pediatric septic shock. JAMA 266:1242–1245.PubMedCrossRefGoogle Scholar
  17. 17.
    Ognibene FP, Parker MM, Natanson C, Shelhamer JH, Parrillo JE (1988) Depressed left ventricular performance: Response to volume infusion in patients with sepsis and septic shock. Chest 93:903–910.PubMedCrossRefGoogle Scholar
  18. 18.
    Martin C, Eon B, Saux P, Aknin P, Gouin F (1990) Renal effects of norepinephrine used to treat septic shock patients. Crit Care Med 18:282–285.CrossRefGoogle Scholar
  19. 19.
    Vincent JL, Roman A, Kahn RJ (1990) Dobutamine administration in septic shock: Addition to a standard protocol. Crit Care Med 18:689–693.PubMedCrossRefGoogle Scholar
  20. 20.
    Moran JL, O’Fathartaigh MS, Peisach AR, Chapman MJ, Leppard P (1993) Epinephrine as an inotropic agent in septic shock: A dose-profile analysis. Crit Care Med 21:70–77.PubMedCrossRefGoogle Scholar
  21. 21.
    Tuchschmidt J, Fried J, Astiz M, Rackow E (1992) Elevation of cardiac output and oxygen delivery improves outcome in septic shock. Chest 102:216–220.PubMedCrossRefGoogle Scholar
  22. 22.
    Gattinoni L, Brazzi L, Pelosi P, et al (1995) A trial of goal-oriented hemodynamic therapy in critically ill patients. N Engl J Med 333:1025–1032.PubMedCrossRefGoogle Scholar

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© Springer-Verlag Berlin Heidelberg 1996

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  • M. M. Parker

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