Hypotension and Shock

  • John Victor Peter
  • Mathew Pulicken


  • Shock is a life-threatening, generalised form of acute circulatory failure associated with inadequate oxygen utilisation by the cells.

  • Shock may result in macrocirculatory and microcirculatory abnormalities.

  • Management components include recognition of pattern of shock, selecting appropriate treatment, specific therapy for the underlying problem and monitoring clinical response.

  • Resuscitation goals are based on “VIP” rule: V for ventilate, I for infuse and P for pump.

  • Lactate, mixed venous oxygen saturation and serial cardiac output measurements may help monitor response to therapy.


Mean Arterial Pressure Cardiogenic Shock Circulatory Shock Shock Reversal Tissue Hypoperfusion 
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  1. 1.
    Cecconi M, Backer DD, Antonelli M, et al. Consensus on circulatory shock and hemodynamic monitoring. Task force of the European Society of Intensive Care Medicine. Intensive Care Med. 2014;40:1795–815.CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Vincent JL, Backer DD. Circulatory shock. N Engl J Med. 2013;369:1726–34.CrossRefPubMedGoogle Scholar
  3. 3.
    Vincent JL, Ince C, Bakker J. Circulatory shock – an update: a tribute to Professor Max Harry Weil. Crit Care. 2012;16:239.CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Perner A, Haase N, Wiis J, White JO, Delaney A, et al. Central venous oxygen saturation for the diagnosis of low cardiac output in septic shock patients. Acta Anaesthesiol Scand. 2010;54:98–102.CrossRefPubMedGoogle Scholar
  5. 5.
    Vallée F, Vallet B, Mathe O, Parraguette J, Mari A, Silva S, et al. Central venous-to-arterial carbon dioxide difference: an additional target for goal-directed therapy in septic shock? Intensive Care Med. 2008;34:2218–25.CrossRefPubMedGoogle Scholar
  6. 6.
    Mahajan RK, Peter JV, John G, Graham PL, Rao SV, Pinsky MR. Patterns of central venous oxygen saturation, lactate and veno-arterial CO2 difference in patients with septic shock. Indian J Crit Care Med. 2015;19:580–6.Google Scholar

Further Reading

  1. John G, Peter JV, Subramani K, Pichamuthu K, Chacko B. Essentials of critical care, volume I, 8th Edition. Division of Critical Care, Christian Medical College, Vellore. 2011.Google Scholar
  2. Okorie ON, Dellinger P. Lactate: biomarker and potential therapeutic target. Crit Care Clin. 2011;27:299–326.CrossRefPubMedGoogle Scholar
  3. Overgaard CB, Dzavik V. Inotropes and vasopressors. Review of physiology and clinical use in cardiovascular disease. Circulation. 2008;118:1047–56.CrossRefPubMedGoogle Scholar

Copyright information

© Springer India 2016

Authors and Affiliations

  1. 1.Medical Intensive Care UnitChristian Medical CollegeVelloreIndia
  2. 2.Intensive Care UnitPushpagiri Medical College HospitalThiruvallaIndia

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