[Septic shock. Clinical review of 72 cases (author's transl)]

The authors present a series of 72 observations of septic shock. The overall hospital mortality is 51%. Aggravating factors with worst prognosis are a cirrhosis (90% mortality) and wrong antibiotics before shock occurred (88% mortality). Some therapeutic acts (cannulae, venous catheter, urinary catheter, immuno-depressing treatment) increase penetration of gram positive germs of hostipal origin. The germs account for 30% of cases, the most frequent being staphylococcus. Among gram-negative organisms, one finds colibacilli, pseudomonas and last klebsiella. Usual entrance site was respiratory (33%). On clinical grounds we found equal frequency of "warm" shock with vasodilatation (mortality 30%) and "cold" shock (mortality 67%). A certain degree of renal failure sometimes necessitating dialysis is the rule. Intravascular disseminated coagulation occurred 3 times out of 46; 13 had hemorrhage. Finally acid-base disorders were usually of the metabolic acidosis type with respiratory alkalosis. Treatment consists in restauring volemia with abundant perfusions under control of central venous and arterial pressures and diuresis. Antibiotherapy, bactericidal and with wide spectre or specific for the suspected germ, must be immediately started. Importance of surgical debridement when required is evidenced by the low mortality of those cases (2 deaths out of 12). We use steroids systematically at high dosage, intravenous. Vasoactive or tonicardiac drugs are used selectively. Their efficiency and that of steroids are not prooved. Finally a review of the literature concerning the physiopathology and treatment of septic shock and its complications is presented.