| Septic shock Classification and external resources |
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| ICD-10 | A41. The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify Diseases The International Statistical Classification of Diseases and Related Health Problems 10th Revision ( ICD -10) is a coding of diseases and signs symptoms abnormal findings 9 |
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| ICD-9 | 785.52 |
Septic shock is a very serious medical condition caused by decreased tissue perfusion and oxygen delivery as a result of infection and sepsis. The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify Diseases The following is a list of codes for International Statistical Classification of Diseases and Related Health Problems. Medicine is the art and science of healing It encompasses a range of Health care practices evolved to maintain and restore Human Health by the An infection is the detrimental Colonization of a host Organism by a foreign Species. Sepsis is a serious medical condition characterized by a whole-body inflammatory state (called a Systemic inflammatory response syndrome or SIRS caused It can cause multiple organ failure and death. Multiple organ dysfunction syndrome (MODS, previously known as multiple organ failure (MOF, is altered organ function in an acutely ill patient requiring Death is the termination of the biological functions that define living Organisms It refers both to a specific Its most common victims are children, immunocompromised individuals, and the elderly, as their immune systems cannot deal with the infection as effectively as those of healthy adults. In Medicine, immunodeficiency (or immune deficiency) is a state in which the Immune system 's ability to fight Infectious disease is compromised An immune system is a collection of mechanisms within an Organism that protects against Disease by identifying and killing Pathogens and Tumor The mortality rate from septic shock is approximately 50%. Mortality rate is a measure of the number of Deaths (in general or due to a specific cause in some population scaled to the size of that population per unit time
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Definition of septic shock
To diagnose septic shock[1] the following two criteria must be met:
- Evidence of infection, through a positive blood culture. Blood culture is Microbiological culture of Blood. It is employed to detect Infections that are spreading through the bloodstream ( Bacteremia,
- Refractory hypotension - hypotension despite adequate fluid resuscitation and cardiac output. In Physiology and Medicine, hypotension refers to an abnormally low Blood pressure. Fluid replacement or fluid resuscitation is the medical practice of replenishing bodily fluid lost through sweating bleeding fluid shifts or other pathologic processes Cardiac output (Q is the volume of blood being pumped by the Heart, in particular by a ventricle in a minute
- In adults it is defined as a systolic blood pressure < 90 mmHg, or a MAP < 60 mmHg, without the requirement for inotropic support, or a reduction of 40 mmHg in the systolic blood pressure from baseline. Blood pressure is also the title of a short story by Damon Runyan in Guys and Dolls and Other Stories The torr (symbol Torr) is a non- SI unit of Pressure defined as 1/760 of an atmosphere. The mean arterial pressure ( MAP) is a term used in medicine to describe a notional average Blood pressure in an individual An inotrope (ˈaɪnətroʊp is an agent that alters the force or energy of Muscular contractions Negatively inotropic agents weaken the force of muscular contractions
- In children it is BP < 2 SD of the normal blood pressure. In Probability and Statistics, the standard deviation is a measure of the dispersion of a collection of values
In addition to the two criteria above, two or more of the following must be present:
- Hyperventilation (high respiratory rate) > 20 breaths per minute or, on blood gas, a PaCO2 less than 32 mmHg. In Medicine, hyperventilation (or overbreathing) is the state of Breathing faster and/or deeper than necessary bringing about lightheadedness and other An arterial blood gas ( ABG) is a Blood test that is performed specifically on Blood from an Artery.
- White blood cell count < 4000 cells/mm³ or > 12000 cells/mm³ (< 4 x 109 or > 12 x 109 cells/L).
Types
A subclass of distributive shock, shock refers specifically to decreased tissue perfusion resulting in end-organ dysfunction. Distributive shock is as in Hypovolemic shock, caused by an insufficient Intravascular volume of Blood. In Physiology, perfusion is the process of nutritive delivery of Arterial Blood to a Capillary bed in the Biological tissue. Cytokines TNFα, IL-1β, IL-6 released in a large scale inflammatory response results in massive vasodilation, increased capillary permeability, decreased systemic vascular resistance, and hypotension. Cytokines are a category of signalling Proteins and Glycoproteins that like Hormones and Neurotransmitters, are used extensively in cellular Tumor necrosis factor ( TNF, cachexin or cachectin and formally known as Tumor necrosis factor-alpha) is a Cytokine involved in systemic Capillaries are the smallest of a body's Blood vessels measuring 5-10 μm in diameter which connect Arterioles and Venules and enable the interchange In Physiology and Medicine, hypotension refers to an abnormally low Blood pressure. Hypotension reduces tissue perfusion pressure and thus tissue hypoxia ensues. Chronic Hypoxia is a pathological condition in which the body as a whole ( generalized hypoxia) or region of the body ( tissue hypoxia) is deprived of adequate Finally, in an attempt to offset decreased blood pressure, ventricular dilatation and myocardial dysfunction will occur. Blood pressure is also the title of a short story by Damon Runyan in Guys and Dolls and Other Stories Myocardium is the muscular tissue of the Heart. Relationship to other layers The other tissues of the heart are the Endocardium
Causes
The process of infection by bacteria or fungi can result in systemic signs and symptoms that are variously described. In rough order of increasing severity, these are bacteremia or fungemia; septicemia; sepsis, severe sepsis or sepsis syndrome; septic shock; refractory septic shock; multiple organ dysfunction syndrome, and death. Bacteremia ( Bacteræmia in British English is the presence of bacteria in the Blood. Fungemia (also known as Candidemia, Candedemia, and Invasive Candidiasis) is the presence of fungi or Yeasts in the Blood Sepsis is a serious medical condition characterized by a whole-body inflammatory state (called a Systemic inflammatory response syndrome or SIRS caused Sepsis is a serious medical condition characterized by a whole-body inflammatory state (called a Systemic inflammatory response syndrome or SIRS caused Multiple organ dysfunction syndrome (MODS, previously known as multiple organ failure (MOF, is altered organ function in an acutely ill patient requiring Death is the termination of the biological functions that define living Organisms It refers both to a specific
The condition develops as a response to certain microbial molecules which trigger the production and release of cellular mediators, such as tumor necrosis factors (TNF); these act to stimulate immune response. A microorganism (also spelled micro organism or micro-organism and also called a microbe) is an Organism that is Microscopic (usually Tumor necrosis factors (or the TNF-family) refers to a group of Cytokines family that can cause Apoptosis. Besides TNFα, other cytokines involved in the development of septic shock include interleukin-1β, interleukin-6 and interleukin-8. Tumor necrosis factor ( TNF, cachexin or cachectin and formally known as Tumor necrosis factor-alpha) is a Cytokine involved in systemic Cytokines are a category of signalling Proteins and Glycoproteins that like Hormones and Neurotransmitters, are used extensively in cellular Interleukins are a group of Cytokines (secreted Signaling molecules) that were first seen to be expressed by White blood cells ( Leukocytes hence
Treatment
Treatment primarily consists of the following.
- Volume resuscitation.
- Early antibiotic administration.
- Rapid source identification and control.
- Support of major organ dysfunction.
Among the choices for pressors, a randomized controlled trial concluded that there was no difference between norepinephrine (plus dobutamine as needed for cardiac output) versus epinephrine. A randomized controlled trial (RCT is a type of scientific Experiment most commonly used in testing the Efficacy or Effectiveness of Healthcare Norepinephrine ( INN) (abbreviated norepi or NE) or noradrenaline ( BAN) (abbreviated NA or NAd) is a Dobutamine is a Sympathomimetic Drug used in the treatment of Heart failure and Cardiogenic shock. Cardiac output (Q is the volume of blood being pumped by the Heart, in particular by a ventricle in a minute [2]
However dopamine has more beta adrenergic activity and therefore is more likely to cause arrhythmia or myocardial infarction.
Antimediator agents may be of some limited use in severe clinical situations:
- Corticosteroids, especially if combined with a mineralocorticoid, can reduce mortality among patients who have relative adrenal insufficiency. Corticosteroids are a class of Steroid hormones that are produced in the Adrenal cortex. Mineralocorticoids are a class of Steroid hormones characterised by their similarity to Aldosterone and their influence on salt and water balance Adrenal insufficiency is a condition in which the Adrenal glands located above the Kidneys do not produce adequate amounts of steroid hormones (chemicals produced by the [3]
- Recombinant activated protein C (drotrecogin alpha) has been shown in large randomized clinical trials to be associated with reduced mortality (Number needed to treat (NNT) of 16) in patients with multi-organ failure. Recombinant DNA is a form of synthetic DNA that is engineered through the combination or insertion of one or more DNA strands thereby combining DNA sequences Protein C is a major physiological Anticoagulant. It is a Vitamin K -dependent Serine protease Enzyme ( that is activated by Thrombin Drotrecogin alfa (activated ( Xigris, marketed by Eli Lilly and Company) is a Recombinant form of human activated Protein C that has The number needed to treat (NNT is an epidemiological measure used in assessing the effectiveness of a health-care intervention typically a treatment with Medication [4] If this is given, heparin should probably be continued. Heparin, a highly-sulfated Glycosaminoglycan, is widely used as an injectable Anticoagulant and has the highest negative Charge density of any known [5]
References
- ^ Tslotou AG, Sakorafas GH, Anagnostopoulos G, Bramis J. Septic shock; current pathogenetic concepts from a clinical perspective. Med Sci Monit. 2005 Mar;11(3):RA76-85. PMID 15735579 Full Text.
- ^ Annane D, Vignon P, Renault A, et al (2007). "Norepinephrine plus dobutamine versus epinephrine alone for management of septic shock: a randomised trial". Lancet 370 (9588): 676-84. doi:. A digital object identifier ( DOI) is a permanent identifier given to an Electronic document. PMID 17720019.
- ^ Annane D, Sebille V, Charpentier C, Bollaert PE, Francois B, Korach JM, Capellier G, Cohen Y, Azoulay E, Troche G, Chaumet-Riffaut P, Bellissant E. Effect of treatment with low doses of hydrocortisone and fludrocortisone on mortality in patients with septic shock. JAMA. 2002 Aug 21;288(7):862-71. PMID 12186604
- ^ Bernard GR, Vincent JL, Laterre PF, LaRosa SP, Dhainaut JF, Lopez-Rodriguez A, Steingrub JS, Garber GE, Helterbrand JD, Ely EW, Fisher CJ Jr; Recombinant human protein C Worldwide Evaluation in Severe Sepsis (PROWESS) study group. Efficacy and safety of recombinant human activated protein C for severe sepsis. N Engl J Med. 2001 Mar 8;344(10):699-709. PMID 11236773
- ^ Levi M, Levy M, Williams MD, et al (2007). "Prophylactic heparin in patients with severe sepsis treated with drotrecogin alfa (activated)". Am. J. Respir. Crit. Care Med. 176 (5): 483–90. doi:. A digital object identifier ( DOI) is a permanent identifier given to an Electronic document. PMID 17556722.
See also
- Anaphylactic shock
- Cardiogenic shock
- Neurogenic shock
- Sepsis
- Shock
- Systemic inflammatory response syndrome (SIRS)
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