Septic shock of endotoxin type: Some observations based on the management of 50 patients

Abstract

Septic shock of the endotoxin type remains of major importance because of persisting high mortality rates. Theories of pathogenesis remain mutually contradictory in many respects, and more basic work is required in this area. The treatment of this condition remains controversial. Fifty cases of septic shock in gynecologic and obstetric patients are reviewed. In 44 women the condition was associated with pregnancy. Septic abortion, chorioamnionitis, and pyelonephritis were the main sources of the infection. Methods of monitoring the patient in septic shock with special attention to blood pressure, central venous pressure, blood volume changes, and urinary output are discussed. Early surgical intervention and the proper use of vasopressors and corticosteroids in pharmacologic doses yielded good results in terms of patient survival. The mortality rate was 26 per cent in the first 6 years of the study and 5.3 per cent in the last 21 months. The over-all mortality rate was 18 per cent.