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Septic Shock pp 161-178 | Cite as

The Circulatory Defect of Septic Shock

  • L. G. Thijs
  • A. B. J. Groeneveld
Part of the Update in Intensive Care and Emergency Medicine book series (UICM, volume 4)

Abstract

Septic shock in man is generally characterized by a normal or mostly increased cardiac output (CO), a decreased systemic vascular resistance (SVR), a decreased arterio-mixed venous oxygen content difference \((Ca - \bar{v}{{O}_{2}})\) and elevated blood lactate levels [1–9]. This hyperdynamic profile is usually observed in the earlier stages of this highly lethal disease but a significant number of patients show such a pattern throughout the course of their illness.

Keywords

Septic Shock Septic Shock Patient Blood Lactate Level Myocardial Depression Circ Shock 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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References

  1. 1.
    Siegel JH, Greenspan M, Del Guercio LRM (1967) Abnormal vascular tone, defective oxygen transport and myocardial failure in human septic shock. Ann Surg 165: 504–517PubMedCrossRefGoogle Scholar
  2. 2.
    Cohn JD, Greenspan M, Goldstein CR, Gudwin AL, Siegel JH, Del Guercio LRM (1968) Arteriovenous shunting in high cardiac output shock syndromes. Surg Gynecol Obstet 127: 282–288PubMedGoogle Scholar
  3. 3.
    Wilson RF, Sarver EJ, LeBlanc PL (1971) Factors affecting hemodynamics in clinical shock with sepsis. Ann Surg 174: 939–943PubMedCrossRefGoogle Scholar
  4. 4.
    Winslow EJ, Loeb HS, Rahimtoola SH, Kamath S, Gunnar RM (1973) Hemodynamic studies and results of therapy in 50 patients with bacteremic shock. Am J Med 54: 421–432PubMedCrossRefGoogle Scholar
  5. 5.
    Weisel RD, Vito L, Dennis RC, Valeri CR, Hechtmann HB (1977) Myocardial depression during sepsis. Am J Surg 133: 512–521PubMedCrossRefGoogle Scholar
  6. 6.
    Wiles JB, Cerra FB, Siegel JH, Border JR (1980) The systemic septic response: does the organism matter? Crit Care Med 8: 55–60PubMedCrossRefGoogle Scholar
  7. 7.
    Hess ML, Hastillo A, Greenfield LJ (1981) Spectrum of cardiovascular function during gram-negative sepsis. Prog Cardiovasc Dis 23: 279–298PubMedCrossRefGoogle Scholar
  8. 8.
    Parker MM, Shelhamer JH, Bacharach SL, et al (1984) Profound but reversible myocardial depression in patients with septic shock. Ann Intern Med 100: 483–490PubMedGoogle Scholar
  9. 9.
    Groeneveld ABJ, Bronsveld W, Thijs LG (1986) Hemodynamic determinants of mortality in human septic shock. Surgery 99: 140–152PubMedGoogle Scholar
  10. 10.
    Blain CM, Anderson TO, Pietras RJ, Gunnar RM (1970) Immediate hemodynamic effects of gram-negative vs gram-positive bacteremia in man. Arch Intern Med 126: 260–265PubMedCrossRefGoogle Scholar
  11. 11.
    Gunnar RM, Loeb HS, Winslow EJ, Blain C, Robinson J (1973) Hemodynamic measurements in bacteremia and septic shock in man. J Infect Dis 128: S295–298CrossRefGoogle Scholar
  12. 12.
    Robinson JA, Klodnycky ML, Loeb HS, Racic MR, Gunnar RM (1975) Endotoxin, prekallikrein, complement and systemic vascular resistance. Am J Med 59: 61–67PubMedCrossRefGoogle Scholar
  13. 13.
    Kwaan HM, Weil MH (1969) Differences in the mechanism of shock caused by bacterial infections. Surg Gynecol Obstet 128: 37–45PubMedGoogle Scholar
  14. 14.
    Cronenwett JL, Lindenauer SM (1979) Direct measurement of arteriovenous anastomotic blood flow in the septic canine hindlimb. Surgery 85: 275–282PubMedGoogle Scholar
  15. 15.
    Archie JP Jr (1977) Anatomic arterio-venous shunting in endotoxic and septic shock in dogs. Ann Surg 186: 171–176PubMedCrossRefGoogle Scholar
  16. 16.
    Lambalgen AA van, Bronsveld W, Bos GC van den, Thijs LG (1984) Distribution of cardiac output, oxygen consumption and lactate production in canine endotoxin shock. Cardiovasc Res 18: 195–205PubMedCrossRefGoogle Scholar
  17. 17.
    Finley RJ, Duff JH, Holliday RL, Jones D, Marchuk JB (1975) Capillary muscle blood flow in human sepsis. Surgery 78: 87–94PubMedGoogle Scholar
  18. 18.
    Houtchens BA, Westenskow DR (1984) Oxygen consumption in septic shock. Circ Shock 13: 361–384PubMedGoogle Scholar
  19. 19.
    Sprung C, Schultz DR, Marcial E, et al (1986) Complement activation in septic shock patients. Crit Care Med 14: 525–528PubMedCrossRefGoogle Scholar
  20. 20.
    Thijs LG, Nuyens JH, Hack CE (1987) Role of complement activation in human sepsis and septic shock. In: Vincent JL (ed) Update in Intensive Care and Emergency Medicine Vol. 3. Springer, Berlin Heidelberg New York London Paris Tokyo, pp 55–62Google Scholar
  21. 21.
    Parker MM, Ognibene FP, Natanson C, et al (1985) Elevated C5a levels in patients with septic shock. Crit Care Med 13: 303CrossRefGoogle Scholar
  22. 22.
    Whaley K, Yee Khong T, McCartney AG, Ledingham I McA (1979) Complement activation and its control in gram-negative endotoxin shock. J Clin Lab Immunol 2: 117–124Google Scholar
  23. 23.
    Kalter ESJ (1983) Inflammatory mediators in bacterial shock. Thesis, UtrechtGoogle Scholar
  24. 24.
    Ball HA, Cook JA, Wise WC, Halushka (1986) Role of thromboxane, prostaglandins and leukotrienes in endotoxic and septic shock. Intensive Care Med 12: 116–126Google Scholar
  25. 25.
    Thijs LG, Balk E, Tuynman HARE, Koopman PAR, Bezemer PD, Mulder GH (1983) Effects of naloxone on hemodynamics, oxygen transport and metabolic variables in canine endotoxin shock. Circ Shock 10: 147–160PubMedGoogle Scholar
  26. 26.
    Rock P, Silverman H, Plump D, et al (1985) Efficacy and safety of naloxone in septic shock. Crit Care Med 13: 28–33PubMedCrossRefGoogle Scholar
  27. 27.
    Baumgartner JD, Vassey C, Perret C (1984) An extreme form of hyperdynamic syndrome of septic shock. Intensive Care Med 10: 245–249PubMedCrossRefGoogle Scholar
  28. 28.
    Nishijima H, Weil MH, Shubin H, Cavanilles J (1973) Hemodynamic and metabolic studies on shock associated with gram-negative bacteremia. Medicine 5: 287–294CrossRefGoogle Scholar
  29. 29.
    Abraham E, Bland RD, Cobo JC, Shoemaker WC (1984) Sequential cardiorespiratory patterns associated with outcome in septic shock. Chest 85: 75–80PubMedCrossRefGoogle Scholar
  30. 30.
    Clowes GHA, Farrington GH, Zuschneid W, Cossette GR, Saravis C (1970) Circulating factors in the etiology of pulmonary insufficiency and right heart failure accompanying severe sepsis (peritonitis). Ann Surg 171: 663–678PubMedCrossRefGoogle Scholar
  31. 31.
    Clowes GHA, Hirsch E, Williams L, et al (1975) Septic lung and shock lung in man. Ann Surg 181: 681–692PubMedCrossRefGoogle Scholar
  32. 32.
    Shoemaker WC (1971) Cardiorespiratory patterns in complicated and uncomplicated septic shock. Ann Surg 174: 119–125PubMedCrossRefGoogle Scholar
  33. 33.
    Parillo JE (1986) Cardiovascular dysfunction in humans with septic shock. In: Vincent JL (ed) Update in Intensive Care and Emergency Medicine Vol. 1 Springer, Berlin Heidelberg New York London Paris Tokyo, pp 265–274Google Scholar
  34. 34.
    Parillo JE (1985) Cardiovascular dysfunction in septic shock: new insights into a deadly disease. Internat J Cardiol 7: 314–321CrossRefGoogle Scholar
  35. 35.
    Vincent JL, Weil MH, Puri V, Carlson RW (1981) Circulatory shock associated with purulent peritonitis. Am J Surg 142: 262–270PubMedCrossRefGoogle Scholar
  36. 36.
    Thijs LG, Groeneveld ABJ, Schneider AJ (1987) Changing hemodynamic concepts in septic shock. In: Kox W, Bihari D (eds) Septic Shock and the Adult Respiratory Distress Syndrome. Springer, Berlin Heidelberg New York London Paris Tokyo (in press)Google Scholar
  37. 37.
    Calvin JE, Driedger AA, Sibbald WJ (1981) An assessment of myocardial function in human sepsis utlizing ECG gated cardiac scintigraphy. Chest 80: 579–586PubMedCrossRefGoogle Scholar
  38. 38.
    Hoffman MJ, Greenfield LJ, Sugerman HJ, Tatum JL (1983) Unsuspected right ventricular dysfunction in shock and sepsis. Ann Surg 198: 307–319PubMedCrossRefGoogle Scholar
  39. 39.
    Kimchi A, Ellrodt AG, Berman DS, Riedinger MS, Swan HJC, Murata GH (1984) Right ventricular performance in septic shock: a combined radionuclide and hemodynamic study. J Am Coll. Cardiol 4: 945–951Google Scholar
  40. 40.
    Ellrodt AG, Riedinger MS, Kimchi A, et al (1985) Left ventricular performance in septic shock: reversible segmental and global abnormalities. Am Heart J 110: 402–409PubMedCrossRefGoogle Scholar
  41. 41.
    Calvin JE, Driedger AA, Sibbald WJ (1981) The hemodynamic effect of rapid fluid infusion in critically ill patients. Surgery 90: 61–76PubMedGoogle Scholar
  42. 42.
    Sibbald WJ, Paterson NAM, Holliday RL, Anderson RA, Lobb TR, Duff JH (1978) Pulmonary hypertension in sepsis. Measurement by the pulmonary arterial diastolic-pulmonary wedge pressure gradient and the influence of passive and active factors. Chest 73: 583–591Google Scholar
  43. 43.
    Cunnion RE, Schaer GL, Parker MM, Natanson C, Parillo JE (1986) The coronary circulation in human septic shock. Circulation 73: 637–644PubMedCrossRefGoogle Scholar
  44. 44.
    Lefer AM (1979) Mechanisms of cardiodepression in endotoxin shock. Circ Shock Suppl 1: 1–8PubMedGoogle Scholar
  45. 45.
    Parillo JE, Burch C, Shelhamer JH, Parker MM, Natanson C, Schuette W (1985) A circulatory myocardial depressant substance in humans with septic shock: septic shock patients with a reduced ejection fraction have a circulating factor that depresses in vitro myocardial cell performance. J Clin Invest 76: 1539–1544CrossRefGoogle Scholar
  46. 46.
    Clowes GHA, Martin H, Waiji S, Hirsch E, Gazitua R, Goodfellow R (1978) Blood insulin responses to blood glucose levels in high output sepsis and septic shock. Am J Surg 135: 577–583PubMedCrossRefGoogle Scholar
  47. 47.
    Cerra FB, Hassett J, Siegel JH (1978) Vasodilator therapy in clinical sepsis with low output syndrome. J Surg Res 25: 180–183PubMedCrossRefGoogle Scholar
  48. 48.
    Thijs LG, Teule GJJ (1983) Is venous pooling an important factor in shock? In: Lewis DH and Haglund U (eds) Shock Research. Elsevier Science Publishers BV, pp 89–99Google Scholar
  49. 49.
    Teule GJJ, Lingen A van, Verweij-van Vught MAAJ, et al (1984) Role of peripheral pooling in porcine Escherichia coli sepsis. Circ Shock 12: 115–123PubMedGoogle Scholar
  50. 50.
    Teule GJJ, Hollander W den, Bronsveld W, et al (1983) Effect of volume loading and dopamine on hemodynamics and red-cell redistribution in canine endotoxin shock. Circ Shock 10: 41–50PubMedGoogle Scholar
  51. 51.
    Groeneveld ABJ, Nauta JJP, Thijs LG (1987) Peripheral vascular resistance in septic shock: its relation to outcome. Intensive Care Med (in press)Google Scholar
  52. 52.
    Siegel JH, Giovannini I, Cerra FB, Nespoli A (1982) Pathologic synergy in cardiovascular and respiratory compensation with cirrhosis and sepsis. A manifestation of a common metabolic defect? Arch Surg 117: 225–238PubMedGoogle Scholar
  53. 53.
    Nespoli A, Chiara O, Clement MG, Dagnino G, Bevilacqua G, Aguggini G (1983) The cardiorespiratory impairment in cirrhosis and sepsis. An experimental interpretation using octopamine infusion. Circ Shock 10: 15–30Google Scholar
  54. 54.
    Duff JH, Groves AC, McLean APH, LaPointe R, MacLean LD (1969) Defective oxygen consumption in septic shock. Surg Gynecol Obstet 128: 1051–1060PubMedGoogle Scholar
  55. 55.
    Weil MH, Afifi AA (1970) Experimental and clinical studies on lactate and pyruvate as indicators of severity of acute circulatory failure (shock). Circulation 41: 989–1001PubMedGoogle Scholar
  56. 56.
    Gilbert EM, Haupt MT, Mandanas RY, Huaringa AJ, Carlson RW (1986) The effect of fluid loading, blood transfusion, and catecholamine infusion on oxygen delivery and consumption in patients with sepsis. Am Rev Respir Dis 134: 873–878PubMedGoogle Scholar
  57. 57.
    Haupt MT, Gilbert EM, Carlson RW (1985) Fluid loading increases oxygen consumption in septic patients with lactic acidosis. Am Rev Respir Dis 131: 912–916PubMedGoogle Scholar
  58. 58.
    Kaufman BS, Rackow EC, Falk JL (1984) The relationship between oxygen delivery and consumption during fluid resuscitation of hypovolemic and septic shock. Chest 85: 336–340PubMedCrossRefGoogle Scholar
  59. 59.
    Cain SM (1984) Supply dependency of oxygen uptake in ARDS: myth or reality? Am J Med Sci 288: 119–124PubMedCrossRefGoogle Scholar
  60. 60.
    Groeneveld ABJ, Kester ADM, Nauta JJP, Thijs LG (1987) The relation of arterial blood lactate to oxygen delivery and hemodynamic variables in human shockstates. Circ Shock 22: 35–53PubMedGoogle Scholar
  61. 61.
    Ellsworth ML, Goldfarb RD, Alexander RS, Bell DR, Powers SR Jr (1981) Microembolization induced oxygen utilization impairment in the canine gracilis muscle. Adv Shock Res 5: 89–99PubMedGoogle Scholar
  62. 62.
    Shah DM, Newell JC, Saba TM (1981) Defects in peripheral oxygen utilization following trauma and shock. Arch Surg 116: 1277–1281PubMedGoogle Scholar
  63. 63.
    Landau SE, Alexander RS, Powers SR Jr (1982) Tissue oxygen exchange and reactive hyperemia following microembolization. J Surg Res 32: 38–43PubMedCrossRefGoogle Scholar
  64. 64.
    Shah DM, Dutton RE, Newell JC, Powers SR Jr (1977) Vascular autoregulatory failure following trauma and shock. Surg Forum 28: 11–13PubMedGoogle Scholar
  65. 65.
    Beer G, Yonce LR (1972) Blood flow, oxygen uptake and capillary filtration in resting skeletal muscle. Am J Physiol 223: 492–498PubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 1987

Authors and Affiliations

  • L. G. Thijs
  • A. B. J. Groeneveld

There are no affiliations available

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