Circulatory Shock: Hypovolemic, Distributive, Cardiogenic, Obstructive

  • J. -L. Vincent
  • A. Rapotec
Part of the Topics in Anaesthesia and Critical Care book series (TIACC)


Circulatory shock is the clinical picture associated with generalized, acute circulatory insufficiency, which is a frequent complication of many pathological states as diverse as severe sepsis, extensive myocardial infarction, polytrauma, or massive pulmonary embolism. Whatever the cause of the shock, cells no longer possess enough oxygen to function optimally, and this condition is associated with high mortality rates. Even in patients who survive the acute episode of shock, protracted cellular damage frequently results in organ dysfunction. Prompt recognition of shock is essential to enable appropriate therapy to be instituted rapidly and tissue damage limited.


Severe Sepsis Cardiogenic Shock Disseminate Intravascular Coagulation Blood Lactate Level Drotrecogin Alfa 
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  1. 1.
    Weil MH, Shubin H (1971) Proposed reclassification of shock states with special reference to distributive defects. Adv Exp Med Biol 23:13–23PubMedGoogle Scholar
  2. 2.
    Goldberg RJ, Gore JM, Thompson CA, Gurwitz JH (2001) Recent magnitude of and temporal trends (1994–1997) in the incidence and hospital death rates of cardiogenic shock complicating acute myocardial infarction: the second national registry of myocardial infarction. Am Heart J 141:65–72PubMedCrossRefGoogle Scholar
  3. 3.
    Lindholm MG, Kober L, Boesgaard S et al (2003) Cardiogenic shock complicating acute myocardial infarction; prognostic impact of early and late shock development. Eur Heart J 24:258–265PubMedCrossRefGoogle Scholar
  4. 4.
    De Backer D (2003) Lactic acidosis. Intensive Care Med 29:699–702PubMedGoogle Scholar
  5. 5.
    Friedman G, Berlot G, Kahn RJ, Vincent JL (1995) Combined measurements of blood lactate concentrations and gastric intramucosal pH in patients with severe sepsis. Crit Care Med 23:1184–1193PubMedCrossRefGoogle Scholar
  6. 6.
    Manikis P, Jankowski S, Zhang H et al (1995) Correlation of serial blood lactate levels to organ failure and mortality after trauma. Am J Emerg Med 13:619–622PubMedCrossRefGoogle Scholar
  7. 7.
    Bakker J, Coffernils M, Leon M et al (1991) Blood lactate levels are superior to oxygen derived variables in predicting outcome in human septic shock. Chest 99:956–962PubMedGoogle Scholar
  8. 8.
    Gutierrez G, Clark C, Brown SD, Price K, Ortiz L, Nelson C (1994) Effect of dobutamine on oxygen consumption and gastric mucosal pH in septic patients. Am J Respir Crit Care Med 150:324–329PubMedGoogle Scholar
  9. 9.
    Maynard N, Bihari D, Beale R et al (1993) Assessment of splanchnic oxygenation by gastric tonometry in patients with acute circulatory failure. JAMA 270:1203–1210PubMedCrossRefGoogle Scholar
  10. 10.
    Doglio GR, Pusajo JF, Egurrola MA et al (1991) Gastric mucosal pH as a prognostic index of mortality in critically ill patients. Crit Care Med 19:1037–1040PubMedCrossRefGoogle Scholar
  11. 11.
    Vincent JL, Creteur J (1998) Gastric mucosal pH (pHi) is definitely obsolete-please tell us more about gastric mucosal PCO2 (PgCO2). Crit Care Med 26:1479–1481PubMedCrossRefGoogle Scholar
  12. 12.
    De Backer D, Creteur J, Preiser JC et al (2002) Microvascular blood flow is altered in patients with sepsis. Am J Respir Crit Care Med 166:98–104PubMedCrossRefGoogle Scholar
  13. 13.
    De Backer D, Creteur J, Dubois MJ et al (2004) Microvascular alterations in patients with acute severe heart failure and cardiogenic shock. Am Heart J 147:91–99PubMedCrossRefGoogle Scholar
  14. 14.
    Sakr Y, Dubois MJ, De Backer D et al (2004) Persistent microcirculatory alterations are associated with organ failure and death in patients with septic shock. Crit Care Med 32:1825–1831PubMedCrossRefGoogle Scholar
  15. 15.
    Creteur J, De Backer D, Sakr Y et al (2006) Sublingual capnometry tracks microcirculatory changes in septic patients. Intensive Care Med 32:516–523PubMedCrossRefGoogle Scholar
  16. 16.
    De Backer D, Verdant C, Chierego M et al (2006) Effects of drotrecogin alfa activated on microcirculatory alterations in patients with severe sepsis. Crit Care Med 34:1918–1924PubMedCrossRefGoogle Scholar
  17. 17.
    Weil MH, Shubin H (1969) The “VIP” approach to the bedside management of shock. JAMA 207:337–34PubMedCrossRefGoogle Scholar
  18. 18.
    Vincent JL, Weil MH (2006) Fluid challenge revisited. Crit Care Med 34:1333–1337PubMedCrossRefGoogle Scholar
  19. 19.
    Finfer S, Bellomo R, Boyce N, et al (2004) A comparison of albumin and saline for fluid resuscitation in the intensive care unit. N Engl J Med 350:2247–2256PubMedCrossRefGoogle Scholar
  20. 20.
    Vincent JL, Dubois MJ, Navickis RJ, Wilkes MM (2003) Hypoalbuminemia in acute illness: is there a rationale for intervention? A meta-analysis of cohort studies and controlled trials. Ann Surg 237:319–334PubMedCrossRefGoogle Scholar
  21. 21.
    Vincent JL, Navickis RJ, Wilkes MM (2004) Morbidity in hospitalized patients receiving human albumin: a meta-analysis of randomized, controlled trials. Crit Care Med 32:2029–2038PubMedCrossRefGoogle Scholar
  22. 22.
    Dellinger RP, Carlet JM, Masur H et al (2004) Surviving Sepsis Campaign guidelines for management of severe sepsis and septic shock. Crit Care Med 32:858–873PubMedCrossRefGoogle Scholar
  23. 23.
    Bellomo R, Chapman M, Finfer S et al (2000) Low-dose dopamine in patients with early renal dysfunction: a placebo-controlled randomised trial. Australian and New Zealand Intensive Care Society (ANZICS) Clinical Trials Group. Lancet 356:2139–2143PubMedCrossRefGoogle Scholar
  24. 24.
    Vincent JL, Roman A, Kahn RJ (1990) Dobutamine administration in septic shock: addition to a standard protocol. Crit Care Med 18:689–693PubMedCrossRefGoogle Scholar
  25. 25.
    Kwan I, Bunn F, Roberts I (2001) Timing and volume of fluid administration for patients with bleeding following trauma. Cochrane Database Syst Rev CD002245Google Scholar
  26. 26.
    Duvernoy CS, Bates ER (2005) Management of cardiogenic shock attributable to acute myocardial infarction in the reperfusion era. J Intensive Care Med 20:188–198PubMedCrossRefGoogle Scholar
  27. 27.
    Bernard GR, Vincent JL, Laterre PF et al (2001) Efficacy and safety of recombinant human activated protein C for severe sepsis. N Engl J Med 344:699–709PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Italia 2007

Authors and Affiliations

  • J. -L. Vincent
    • 1
  • A. Rapotec
    • 1
  1. 1.Department of Intensive Care, Erasme University HospitalFree University of BrusselsBelgium

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