From the Guidelines
Sepsis is a form of distributive shock, characterized by widespread inflammation and vasodilation that leads to inadequate tissue perfusion despite potentially normal or even elevated cardiac output. In septic shock, pathogens trigger an overwhelming immune response that causes blood vessels to dilate excessively, resulting in decreased systemic vascular resistance and relative hypovolemia. This differs from other shock types like cardiogenic (heart failure), hypovolemic (fluid loss), or obstructive (physical blockage) shock. The hallmark of septic shock is the maldistribution of blood flow throughout the body, where despite adequate blood volume and cardiac function, tissues cannot receive proper oxygen and nutrients due to microcirculatory dysfunction.
Key Characteristics of Sepsis
- Widespread inflammation and vasodilation
- Inadequate tissue perfusion
- Decreased systemic vascular resistance
- Relative hypovolemia
- Maldistribution of blood flow throughout the body
Treatment of Sepsis
Treatment typically involves:
- Early administration of broad-spectrum antibiotics to address the underlying infection
- Aggressive fluid resuscitation (often starting with 30 mL/kg crystalloid) as recommended by the Surviving Sepsis Campaign guidelines 1
- Vasopressors like norepinephrine (starting at 0.05-0.1 mcg/kg/min) when fluids alone are insufficient
- Source control of infection Early recognition and intervention are crucial, as mortality increases significantly with delayed treatment. The initial target mean arterial pressure of 65 mm Hg in patients with septic shock requiring vasopressors is recommended 1.
Importance of Early Recognition and Intervention
- Mortality increases significantly with delayed treatment
- Early administration of broad-spectrum antibiotics and aggressive fluid resuscitation are critical
- Source control of infection is essential to prevent further complications The Surviving Sepsis Campaign guidelines emphasize the importance of early recognition and intervention in sepsis and septic shock 1.
From the Research
Definition of Sepsis and Shock
- Sepsis is a life-threatening condition that arises when the body's response to infection causes injury to its own tissues and organs [(2,3)].
- Septic shock is a subset of sepsis, characterized by persistent hypotension despite fluid resuscitation and tissue hypoperfusion [(2,3)].
Classification of Shock
- Shock can be classified into different categories, including distributive, hypovolemic, obstructive, and cardiogenic shock 4.
- Distributive shock, which includes septic shock, is the most common type of shock and is characterized by vasodilation and a relative volume deficiency [(4,5)].
Characteristics of Septic Shock
- Septic shock is defined as sepsis-induced hypotension that persists despite adequate fluid resuscitation 3.
- It is characterized by a systolic blood pressure less than 90 mmHg, a mean arterial pressure less than 65 mmHg, or a fall in systolic blood pressure of more than 40 mmHg after a fluid challenge 3.
- Septic shock is a severe condition that requires prompt diagnosis and treatment, including fluid resuscitation and vasopressor administration [(2,3)].