Pathophysiology of shock

2016 ◽  
Author(s):  
Antoine Kimmoun ◽  
Bruno Levy
Keyword(s):  
Intensive Care Unit ◽  
Septic Shock ◽  
Intensive Care ◽  
Intensive Care Unit Admission ◽  
Cardiogenic Shock ◽  
Myocardial Dysfunction ◽  
Cytokine Storm ◽  
Major Consequence ◽  
Tissue Hypoperfusion ◽  
Distributive Shock

Shock remains a major cause of intensive care unit admission. Initially categorized into hypovolaemic, cardiogenic, and distributive shock, understanding of the pathophysiology has recently evolved such that tissue hypoperfusion in all shock states leads to a dysregulated inflammatory response. After 24 hours, septic shock and ischaemiareperfusion related to hypovolaemic and cardiogenic shock share similar haemodynamic and pro-inflammatory profiles. Vascular hyporesponsiveness to catecholamines is a major consequence of this common pathophysiology, which is focused upon activation of NF-κ‎b with subsequent NO overproduction. Myocardial dysfunction is a frequent complication of the cytokine storm that follows septic shock and ischaemiareperfusion. It may worsen haemodynamic status, but nevertheless, remains transient and totally reversible.

scholarly journals Relationship between the presence of dedicated doctors in rapid response systems and patient outcome: a multicenter retrospective cohort study

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Hyung-Jun Kim ◽  
Kyeongman Jeon ◽  
Byung Ju Kang ◽  
Jong-Joon Ahn ◽  
Sang-Bum Hong ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Septic Shock ◽  
Intensive Care ◽  
Propensity Score ◽  
Intensive Care Unit Admission ◽  
Hazard Ratio ◽  
Rapid Response ◽  
Admission Rates ◽  
Rapid Response Systems ◽  
Response Systems

Abstract Background Rapid response systems (RRSs) improve patients’ safety, but the role of dedicated doctors within these systems remains controversial. We aimed to evaluate patient survival rates and differences in types of interventions performed depending on the presence of dedicated doctors in the RRS. Methods Patients managed by the RRSs of 9 centers in South Korea from January 1, 2016, through December 31, 2017, were included retrospectively. We used propensity score-matched analysis to balance patients according to the presence of dedicated doctors in the RRS. The primary outcome was in-hospital survival. The secondary outcomes were the incidence of interventions performed. A sensitivity analysis was performed with the subgroup of patients diagnosed with sepsis or septic shock. Results After propensity score matching, 2981 patients were included per group according to the presence of dedicated doctors in the RRS. The presence of the dedicated doctors was not associated with patients’ overall likelihood of survival (hazard ratio for death 1.05, 95% confidence interval [CI] 0.93‒1.20). Interventions, such as arterial line insertion (odds ratio [OR] 25.33, 95% CI 15.12‒42.44) and kidney replacement therapy (OR 10.77, 95% CI 6.10‒19.01), were more commonly performed for patients detected using RRS with dedicated doctors. The presence of dedicated doctors in the RRS was associated with better survival of patients with sepsis or septic shock (hazard ratio for death 0.62, 95% CI 0.39‒0.98) and lower intensive care unit admission rates (OR 0.53, 95% CI 0.37‒0.75). Conclusions The presence of dedicated doctors within the RRS was not associated with better survival in the overall population but with better survival and lower intensive care unit admission rates for patients with sepsis or septic shock.

scholarly journals Prognostic roles of time to positivity of blood cultures in patients with Escherichia coli bacteremia

2020 ◽  
Vol 148 ◽  
Author(s):  
Yufang Chen ◽  
Xun Huang ◽  
Anhua Wu ◽  
Xuan Lin ◽  
Pengcheng Zhou ◽  
...  
Keyword(s):  
Escherichia Coli ◽  
Intensive Care Unit ◽  
Septic Shock ◽  
Intensive Care ◽  
Intensive Care Unit Admission ◽  
Blood Cultures ◽  
University Teaching ◽  
Clinical Value ◽  
Prognostic Assessment ◽  
Time To Positivity

Abstract The time to positivity (TTP) of blood cultures has been considered a predictor of clinical outcomes for bacteremia. This retrospective study aimed to determine the clinical value of TTP for the prognostic assessment of patients with Escherichia coli bacteremia. A total of 167 adult patients with E.coli bacteremia identified over a 22-month period in a 3500-bed university teaching hospital in China were studied. The standard cut-off TTP was 11 h in the patient cohort. The septic shock occurred in 27.9% of patients with early TTP (⩽11 h) and in 7.1% of those with a prolonged TTP (>11 h) (P = 0.003). The mortality rate was significantly higher for patients in the early than in the late group (17.7% vs. 4.0%, P < 0.001). Multivariate analysis showed that an early TTP (OR 4.50, 95% CI 1.70–11.93), intensive care unit admission (OR 8.39, 95% CI 2.01–35.14) and neutropenia (OR 4.20, 95% CI 1.55–11.40) were independently associated with septic shock. Likewise, the independent risk factors for mortality of patients were an early TTP (OR 3.80, 95% CI 1.04–12.90), intensive care unit admission (OR 6.45; 95% CI 1.14–36.53), a Pittsburgh bacteremia score ⩾2 (OR 4.34, 95% CI 1.22–15.47) and a Charlson Comorbidity Index ⩾3 (OR 11.29, 95% CI 2.81–45.39). Overall, a TTP for blood cultures within 11 h appears to be associated with worse outcomes for patients with E.coli bacteremia.

scholarly journals The assessment of myocardial dysfunction in septic shock patients admitted in intensive care unit by 2-dimensional speckle tracking image

2013 ◽  
Vol 34 (suppl 1) ◽  
pp. P3875-P3875
Author(s):  
S. J. Ha ◽  
H. S. Kim ◽  
J. S. Woo ◽  
S. J. Kim ◽  
W. Kim ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Septic Shock ◽  
Intensive Care ◽  
Speckle Tracking ◽  
Myocardial Dysfunction

scholarly journals Basic and Advanced Echocardiographic Evaluation of Myocardial Dysfunction in Sepsis and Septic Shock

2018 ◽  
Vol 46 (1) ◽  
pp. 13-24 ◽  
Author(s):  
S. Vallabhajosyula ◽  
S. Pruthi ◽  
S. Shah ◽  
B. M. Wiley ◽  
S. V. Mankad ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Septic Shock ◽  
Intensive Care ◽  
Myocardial Dysfunction ◽  
Long Term Outcomes ◽  
Mortality And Morbidity ◽  
Echocardiographic Evaluation ◽  
Short And Long Term ◽  
Sepsis And Septic Shock

Sepsis continues to be a leading cause of mortality and morbidity in the intensive care unit. Cardiovascular dysfunction in sepsis is associated with worse short- and long-term outcomes. Sepsis-related myocardial dysfunction is noted in 20%–65% of these patients and manifests as isolated or combined left or right ventricular systolic or diastolic dysfunction Echocardiography is the most commonly used modality for the diagnosis of sepsis-related myocardial dysfunction. With the increasing use of ultrasonography in the intensive care unit, there is a renewed interest in sepsis-related myocardial dysfunction. This review summarises the current scope of literature focused on sepsis-related myocardial dysfunction and highlights the use of basic and advanced echocardiographic techniques for the diagnosis of sepsis-related myocardial dysfunction and the management of sepsis and septic shock.

scholarly journals Association of Peripartum Cardiomyopathy with Pre-eclampsia and Maternal Outcome

2021 ◽  
pp. 110-115
Author(s):  
Sabreena Abbas ◽  
Sajida Yousfani ◽  
Fouzia Shaikh ◽  
Farhat Sultana ◽  
Najma Shaikh ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Observational Study ◽  
Intensive Care Unit Admission ◽  
Cardiogenic Shock ◽  
Prospective Observational Study ◽  
Peripartum Cardiomyopathy ◽  
University Hospital ◽  
Maternal Complications ◽  
Gynecology And Obstetrics

Objective: To determine the Prevalence of Pre-eclampsia in women with peripartum cardiomyopathy (PPCM) and to compare the maternal outcome in cases of PPCM who develop pre-eclampsia with those cases who are normotensive.      Study design: This is a prospective observational study. Setting: Study carried out at department of Gynecology and Obstetrics, Liaquat university hospital Hyderabad from 20th February 2019 to 19th February 2020. Materials and methods:  This prospective observational study was conducted in department of Gynecology and Obstetrics and department of Cardiology Liaquat University Hospital Hyderabad. Inclusion criteria were patients admitted with a diagnosis of peripartum cardiomyopathy diagnosed clinically and confirmed by echocardiography. Exclusion criteria were cases with multiple pregnancies, smokers, those with chronic hypertension and chronic renal disease or diabetes. We assessed patients for pre-eclampsia. Outcome measures studied were serious maternal complications like Pulmonary oedema, Cardiogenic shock, intensive care unit admission, and death. Results:  During one year study period, there were 71 cases of peripartum cardiomyopathy. The mean age of patients was 29.77±6.8 years. Pre-eclampsia was seen in 62% cases of Peripartum cardiomyopathy. Mean ejection fraction was 33.24±6.49. In patients of PPCM, serious maternal complications including cardiogenic shock 11(15.5%) cases, intensive care unit admission 10(14.1%) cases, pulmonary oedema 35(49.3%) cases and prolonged hospitalization 58(81.7%) cases.  Conclusion: We conclude that pre-eclampsia has high prevalence in patients with PPCM. Both when combined, significantly increase the chances of serious maternal complications including death.

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