Skip to main content
SpringerLink
Log in

Changing Haemodynamic Concepts in Human Septic Shock

  • Chapter
Shock and the Adult Respiratory Distress Syndrome

Part of the book series: Current Concepts in Critical Care ((CRITICAL CARE))

Abstract

Septic shock is associated with complex alterations in haemodynamic variables and cardiovascular performance. Over the last 20 years much information derived from clinical studies has been accumulated. However, uncertainty still exists as to the exact pathophysiological mechanisms underlying these haemodynamic changes which make septic shock such a highly lethal syndrome (more than 50% mortality). Of all patients with sepsis approximately 40% develop profound hypotension and shock. Although it has been appreciated in the last decade that the severity of the underlying disease is a major factor determining ultimate outcome (Kreger et al. 1980; McGabe 1974; Thijs et al. 1984), a thorough understanding of the various cardiovascular changes in septic shock remains essential for appropriate treatment. Together with aggressive therapy of the infectious process with high-dose antimicrobials and surgical eradication of a septic source when necessary, improvement of tissue oxygenation is a prerequisite for survival. Antibiotic treatment as such cannot be expected to affect mechanisms that have already been activated and which deeply disturb systemic haemodynamics, the control mechanisms of the microcirculation, tissue oxygenation and, as a result, cell function. Methods for maintaining or improving tissue oxygenization include optimal pulmonary and circulatory management in order to optimize oxygen delivery. The way this can best be achieved largely depends on the concepts available concerning the nature of the cardiovascular derangements.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 39.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 54.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  • Abraham E, Bland RD, Cobo JC, Shoemaker WC (1984) Sequential cardiorespiratory patterns associated with outcome in septic shock. Chest 85:75–80.

    Article  PubMed  CAS  Google Scholar 

  • Baumgartner JD, Vassey C, Perret C (1984) An extreme form of the hyperdynamic syndrome of septic shock. Intensive Care Med 10:245–249.

    Article  PubMed  CAS  Google Scholar 

  • Bell H, Thal A (1970) The peculiar hemodynamics of septic shock. Postgrad Med J 46:106–114.

    Google Scholar 

  • Blain CM, Anderson TO, Pietras RJ, Gunnar RM (1970) Immediate hemodynamic effects of gram-negative vs gram-positive bacteremia in man. Arch Intern Med 126:260–265.

    Article  PubMed  CAS  Google Scholar 

  • Bronsveld W, van Lambalgen AA, van Velzen D, van den Bos GC, Koopman PAR, Thijs LG (1985) Myocardial metabolic and morphometric changes during canine endotoxin shock before and after glucose-insulin-potassium. Cardiovasc Res 19:455–464.

    Article  PubMed  CAS  Google Scholar 

  • Cain SM (1984) Supply dependency of oxygen uptake in ARDS: myth or reality? Am J Med Sci 288:119–124.

    Article  PubMed  CAS  Google Scholar 

  • Calvin JE, Driedger AA, Sibbald WJ (1981a) The hemodynamic effect of rapid fluid infusion in critically ill patients. Surgery 90:61–76.

    PubMed  CAS  Google Scholar 

  • Calvin JE, Driedger AA, Sibbald WJ (1981b) An assessment of myocardial function in human sepsis utilizing ECG gated cardiac scintigraphy. Chest 80:579–586.

    Article  PubMed  CAS  Google Scholar 

  • Cerra FB, Hassett J, Siegel JH (1978) Vasodilator therapy in clinical sepsis with low output syndrome. J Surg Res 25:180–183.

    Article  PubMed  CAS  Google Scholar 

  • 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 171:663–678.

    Article  PubMed  Google Scholar 

  • Clowes GHA, Hirsch E, Williams L, Kwasnik E, O’Donnell TF, Cuevas P, Saini VK, Moradi I, Farizan M, Saravis C, Stone M, Kuffler J (1975). Septic lung and shock lung in man. Ann Surg 181:681–692.

    Article  PubMed  Google Scholar 

  • 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 135:577–583.

    Article  PubMed  CAS  Google Scholar 

  • Cohn JD, Greenspan M, Goldstein CR, Gudwin AL, Siegel JH, Del Guercio RM (1968) Arteriovenous shunting in high cardiac output shock syndromes. Surg Gynecol Obstet 127:282–288.

    PubMed  CAS  Google Scholar 

  • Cronenwett JL, Lindenauer SM (1979) Direct measurement of arteriovenous anastomotic blood flow in the septic canine hindlimb. Surgery 85:275–282.

    PubMed  CAS  Google Scholar 

  • Ellrodt AG, Riedinger MS, Kimchi A, Berman DS, Maddahi J, Swan HJC, Murata GH (1985) Left ventricular performance in septic shock: reversible segmental and global abnormalities. Am Heart J 110:402–409.

    Article  PubMed  CAS  Google Scholar 

  • Finley RJ, Duff JH, Holliday RL, Jones D, Marchuk JB (1975) Capillary muscle blood flow in human sepsis. Surgery 78:87–94.

    PubMed  CAS  Google Scholar 

  • Goldfarb RD (1982) Cardiac mechanical performance in circulatory shock: a critical review of methods and results. Circ Shock 9:633–653.

    PubMed  CAS  Google Scholar 

  • Groeneveld ABJ, Bronsveld W, Thijs LG (1986) Hemodynamic determinants of mortality in human septic shock. Surgery 99:140–153.

    PubMed  CAS  Google Scholar 

  • 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–S298.

    Article  Google Scholar 

  • Hess ML, Hastillo A, Greenfield LJ (1981) Spectrum of cardiovascular function during gram-negative sepsis. Progr Cardiovasc Dis 23:279–298.

    Article  CAS  Google Scholar 

  • Hinshaw LB, Archer LT, Spitzer JJ, Black MR, Peyton MD, Greenfield LJ (1974) Effects of coronary hypotension and endotoxin on myocardial performance. Am J Physiol 227:1051–1057.

    PubMed  CAS  Google Scholar 

  • Hoffman MJ, Greenfield LJ, Sugerman HJ, Tatum JL (1983) Unsuspected right ventricular dysfunction in shock and sepsis. Ann Surg 198:307–319.

    Article  PubMed  CAS  Google Scholar 

  • Houtchens BA, Westenskow DR (1984) Oxygen consumption in septic shock. Circ Shock 13:361–384.

    PubMed  CAS  Google Scholar 

  • 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 4:945–951.

    Article  PubMed  CAS  Google Scholar 

  • Krausz MM, Perel A, Eimerl D, Cotev S (1977) Cardiopulmonary effects of volume loading in patients in septic shock. Ann Surg 185:429–434.

    Article  PubMed  CAS  Google Scholar 

  • Kreger BE, Craven DE, McGabe WR (1980) Gram-negative bacteremia: re-evaluation of clinical features nd treatment in 612 patients. Am J Med 68:344–355.

    Article  PubMed  CAS  Google Scholar 

  • Kwaan HM, Weil MH (1969) Differences in the mechanism of shock caused by bacterial infections. Surg Gynecol Obstet 128:37–45.

    PubMed  CAS  Google Scholar 

  • Lambalgen AA van, Bronsveld W, van den Bos GC, Thijs LG (1984) Distribution of cardiac output, oxygen consumption and lactate production in canine endotoxin shock. Cardiovasc Res 18:195–205.

    Article  PubMed  Google Scholar 

  • Lefer AM (1979) Mechanisms of cardiodepression in endotoxin shock. Circ Shock [Suppl.] 1:1–8.

    CAS  Google Scholar 

  • Maksad AK, Cha CJ, Stuart RC, Brosco FA, Clowes GHA (1979) Myocardial depression in septic shock: physiologic and metabolic effects of a plasma factor on an isolated heart. Circ Shock [Suppl.] 1:35–42.

    CAS  Google Scholar 

  • McGabe WR (1974) Gram-negative bacteremia. Adv Intern Med 19:135–158.

    Google Scholar 

  • 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 10:15–30.

    PubMed  CAS  Google Scholar 

  • Nishijma H, Weil MH, Shubin H, Cavanilles J (1973) Hemodynamic and metabolic studies on shock associated with gram-negative bacteremia. Medicine 5:287–294.

    Article  Google Scholar 

  • O’Donnell TF, Clowes HA, Talamo RC, Colman RW (1976) Kinin activation in the blood of patients with sepsis. Surg Gynecol Obstet 143:539–545.

    PubMed  Google Scholar 

  • Parillo JE (1985) Cardiovascular dysfunction in septic shock: new insights into a deadly disease. Int J Cardiol 7:314–321.

    Article  Google Scholar 

  • Parker JL, Adams HR (1985) Isolated cardiac preparations: models of intrinsic myocardial dysfunction in circulatory shock. Circ Shock 15:227–245.

    PubMed  CAS  Google Scholar 

  • Parker MM, Shelhamer JH, Natans MC, Miller L, Masur H, Parillo JE (1983) Serial hemodynamic patterns in survivors and non-survivors of septic shock in humans. Clin Res 31:671 A (abstr)

    Google Scholar 

  • Parker MM, Shelhamer JH, Bacharach SL, Green MV, Natanson C, Frederick TM, Damske BA, Parillo JE (1984) Profound but reversible myocardial depression in patients with septic shock. Ann Intern Med 100:483–490.

    PubMed  CAS  Google Scholar 

  • Postel J, Schloerb PR (1977) Cardiac depression in bacteremia. Ann Surg 176:74–82.

    Article  Google Scholar 

  • Reines HD, Halushka PV, Cook JA, Wise WC, Rambo W (1982) Plasma thromboxane concentrations are raised in patients dying with septic shock. Lancet 11:174–175.

    Article  Google Scholar 

  • Robinson JA, Klodnycky ML, Loeb HS, Racic MR, Gunnar RM (1975) Endotoxin, prekallikrein, complement and systemic vascular resistance. Am J Med 59:61–67.

    Article  PubMed  CAS  Google Scholar 

  • Schneider AJ, Teule GJJ, Kester ADM, Heidendal GAK, Thijs LG (1986) Biventricular function during volume loading in porcine E. coli septic shock, with emphasis on right ventricular function. Circ Shock 18:53–63.

    PubMed  CAS  Google Scholar 

  • Shoemaker WC (1971) Cardiorespiratory patterns in complicated and uncomplicated septic shock. Ann Surg 174:119–125.

    Article  PubMed  CAS  Google Scholar 

  • 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 73:583–591.

    Article  PubMed  CAS  Google Scholar 

  • Sibbald W, Peters S, Lindsay RM (1980) Serotonin and pulmonary hypertension in human septic ARDS. Crit Care Med 8:490–494.

    Article  PubMed  CAS  Google Scholar 

  • Siegel JH, Greenspan M, Del Guercio LRM (1967) Abnormal vascular tone, defective oxygen transport and myocardial failure in human septic shock. Ann Surg 165:504–517.

    Article  PubMed  CAS  Google Scholar 

  • Siegel JH, Cerra FB, Coleman B, Giovannini I, Shetye M, Border JM, McMenamy RH (1979) Physiological and metabolic correlation in human sepsis. Surgery 86:163–193.

    PubMed  CAS  Google Scholar 

  • 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 117:225–238.

    PubMed  CAS  Google Scholar 

  • Teule GJJ, van Lingen A, Verweij-van Vught MAAJ, Kester ADM, Mackaay RCM, Bezemer PD, Heidendal GAK, Thijs LG (1984) Role of peripheral pooling in porcine Escherichia coli sepsis. Circ Shock 12:115–123.

    PubMed  CAS  Google Scholar 

  • Teule GJJ, van Lingen A, Schneidger AJ, Verweij-van Vught MAAJ, Kester ADM, Heidendal GAK, Thijs LG (1985) Left and right ventricular function in porcine Escherichia coli sepsis. Circ Shock 15:185–192.

    PubMed  CAS  Google Scholar 

  • Thijs LG, Teule GJJ, Bronsveld W (1984) Problems in the treatment of septic shock. Resuscitation 11:147–155.

    Article  PubMed  CAS  Google Scholar 

  • Udhoji VN, Weil MH (1965) Hemodynamic and metabolic studies on shock associated with bacteremia. Ann Intern Med 62:966–978.

    PubMed  CAS  Google Scholar 

  • Vincent JL, Weil MH, Puri V, Carlson RW (1981) Circulatory shock associated with purulent peritonitis. Am J Surg 142:262–270.

    Article  PubMed  CAS  Google Scholar 

  • Weil MH, Nisjima H (1978) Cardiac output in bacterial shock. Am J Med 64:920–922.

    Article  PubMed  CAS  Google Scholar 

  • Weisel RD, Vito L, Dennis RC, Valeri CR, Hechtman HB (1977) Myocardial depression during sepsis. Am J Surg 133:511–521.

    Article  Google Scholar 

  • Wiles JB, Cerra FB, Siegel JH, Border JR (1980) The systemic septic response: does the organism matter? Crit Care Med 82:55–60.

    Article  Google Scholar 

  • Wilson RF, Thal AP, Kindling PH, Grifka T, Ackerman E (1965) Hemodynamic measurements in septic shock. Arch Surg 91:121–129.

    Google Scholar 

  • Wilson RF, Chiscano AD, Quadros E, Tarver M (1967) Some observations on 132 patients with septic shock. Anesth Analg 46:751–763.

    PubMed  CAS  Google Scholar 

  • Wilson RF, Sarver EJ, LeBlanc PL (1971) Factors affecting hemodynamics in clinical shock with sepsis. Ann Surg 174:939–943.

    Article  PubMed  CAS  Google Scholar 

  • 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 54:421–432.

    Article  PubMed  CAS  Google Scholar 

Download references

Authors
  1. L. G. Thijs
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. A. B. J. Groeneveld
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. A. J. Schneider
    View author publications

    You can also search for this author in PubMed Google Scholar

Editor information

Editors and Affiliations

  1. Department of Anaesthesia, Charing Cross and Westminster Medical School, Fulham Palace Road, London, W6 8RF, England

    Wolfgang Kox MD (Senior Lecturer, Honorary Consultant Anaesthetist (Director, Intensive Care Unit) (Senior Lecturer, Honorary Consultant Anaesthetist (Director, Intensive Care Unit)

  2. Charing Cross Hospital, Fulham Palace Road, London, W6 8RF, England

    Wolfgang Kox MD (Senior Lecturer, Honorary Consultant Anaesthetist (Director, Intensive Care Unit) (Senior Lecturer, Honorary Consultant Anaesthetist (Director, Intensive Care Unit)

  3. Department of Medicine, The Middlesex Hospital Medical School, Mortimer Street, London, W1P 7PN, England

    David Bihari MA, MRCP (Lecturer in Medicine) (Lecturer in Medicine)

Rights and permissions

Reprints and permissions

Copyright information

© 1988 Springer-Verlag Berlin Heidelberg

About this chapter

Cite this chapter

Thijs, L.G., Groeneveld, A.B.J., Schneider, A.J. (1988). Changing Haemodynamic Concepts in Human Septic Shock. In: Kox, W., Bihari, D. (eds) Shock and the Adult Respiratory Distress Syndrome. Current Concepts in Critical Care. Springer, London. https://doi.org/10.1007/978-1-4471-1443-7_6

Download citation

  • DOI: https://doi.org/10.1007/978-1-4471-1443-7_6

  • Publisher Name: Springer, London

  • Print ISBN: 978-1-4471-1445-1

  • Online ISBN: 978-1-4471-1443-7

  • eBook Packages: Springer Book Archive

Publish with us

Policies and ethics

Search

Navigation