Management of septic shock

Septic shock

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Septic shock is the most common type of circulatory shock which is caused by widespread infection. Despite the increase sophistication of antibiotic therapy, the incidence of septic shock has continued to increase due to several predisposing factors that increases the risks of patients acquiring septic shock.

Hospital acquired infections (infections occurring in the hospital setting), in critically ill patients that may progress to septic shock most frequently originate in the bloodstream, lungs, and urinary tract (in decreasing order of frequency). Other infections include intra-abdominal infections, wound infections and infections resulting from prolonged catheterization. Additional risk factors that contribute to the growing incidence of septic shock are increasing awareness and growing incidence of the condition; the increased number of immunocompromised patients (those afflicted with HIV-AIDS); the increased use of invasive surgical procedures and indwelling devices, the increasing number of resistant microorganisms and the increasing number of older adults who are highly susceptible to infection.

Pathophysiology of Septic shock

The most common causative microorganism of septic shock is the gram-negative bacteria. However, there is also an increased in the incidence that gram-positive bacteria are becoming responsible to the growing number of patients having succumbed to septicemia and septic shock. Other infectious agents, such as viruses and fungi, also can cause septic shock.

When microorganisms invade body tissues, patients exhibit an immune response. This immune response provokes the activation of biochemical cytokines and mediators associated with an inflammatory response. Sepsis is an evolving process, with neither clearly definable clinical signs and symptoms nor predictable progression. As the sepsis progresses, tissues become more underperfused and acidic, compensation begins to fail and the patient suffering from septic shock becomes hemodynamically unstable. When sepsis is not treated, it would progress to septic shock  wherein the blood pressure drops and organ dysfunction and failure soon develops.

Medical Management of septic shock

Current treatment of septic shock involves identification and elimination of the cause of infection of the cause of infection. Specimens of blood, sputum and urine, wound drainage and tips of invasive catheters are collected for culture. Any potential routes of infection must be eliminated. IV lines are removed and reinserted at another site. Antibiotic therapy must be constantly monitored and given on time to prevent microorganism resistance. Indwelling catheters must be drained and changed at regular intervals, and abscesses are drained and necrotic areas are débrided. Fluid replacement must be instituted to correct hypovolemia that resulted from the ineffective of the vasculature of the circulatory system. Furthermore, colloids, crystalloids and blood products may be administered to increase the intravascular volume.

Nutritional therapy as an adjunctive treatment of septic shock

Aggressive nutritional supplementation is very essential in the management of septic shock mainly because malnutrition further impairs the patient’s


resistance to infection. Nutritional supplementation should be initiated within the first 24 hours upon the conclusive findings of septicemia. Enteral feedings are preferred to the parenteral route because of the increased risk of infection

associated with IV catheters, however, enteral feedings may not be possible if there is decreased perfusion of the gastrointestinal tract which would result in decreased peristalsis which impairs digestion and absorption which are associated as secondary responses to septic shock.            

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