Septic Shock

Abstract

Sepsis is a leading cause of morbidity and mortality worldwide. Infectious injury leads to inflammation, which leads to additional injury. This cyclical pattern leads to tissue dysfunction, resulting in hypovolemic and vasodilatory shock, hyperdynamic circulatory shock, mitochondrial dysfunction, cellular apoptosis, and immunosuppression. Septic patients are unable to use oxygen effectively, leading to organ dysfunction. The key to management of sepsis is early recognition and treatment. Prompt administration of appropriate antibiotics (preferably but not necessarily following culture) is vital to avoiding the morbidity and mortality associated with sepsis. Aggressive fluid resuscitation resulting in improved blood flow to tissues is the mainstay of initial therapy for septic shock. Balancing the needs for improved preload against the consequences of excessive intravascular volume is paramount. There are many methods (e.g., central venous pressure, mixed/central venous saturation, pulse pressure variation, ultrasonography) to determine when a septic shock patient may no longer respond to fluids and requires vasoconstrictors or inotropes for blood pressure control. Early recognition of sepsis, treatment with appropriate antibiotics, and limiting end-organ damage have led to decreased in-hospital mortality associated with septic shock. This review contains 5 figures, 5 tables, and 105 references. Key Words: antibiotic therapy, fluid therapy, resuscitation, sepsis, shock