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Related Experiment Videos

Sequence of physiologic patterns in surgical septic shock

W C Shoemaker1, P L Appel, H B Kram

  • 1Department of Emergency Medicine, King-Drew Medical Center, Los Angeles, CA.

Critical Care Medicine
|December 1, 1993
PubMed
Summary

Survivors of septic shock exhibit higher cardiac index, oxygen delivery (DO2), and oxygen consumption (VO2) than nonsurvivors. Therapeutic goals should aim to increase these hemodynamic and oxygen transport variables to supranormal levels seen in survivors.

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Area of Science:

  • Critical Care Medicine
  • Hemodynamics
  • Sepsis Pathophysiology

Background:

  • Septic shock involves a continuum from localized infection to systemic failure and death.
  • Understanding sequential hemodynamic and oxygen transport patterns is crucial for differentiating disease progression.

Purpose of the Study:

  • To delineate the sequential hemodynamic and oxygen transport patterns in survivors and nonsurvivors of septic shock.
  • To identify physiological mechanisms and establish a template for relating biochemical mediators to disease progression.

Main Methods:

  • Prospective cohort study involving 300 consecutive surgical patients with septic shock.
  • Defined early (increased cardiac output), middle (maximal oxygen consumption), and late (recovery/death) periods.
  • Frequent monitoring of hemodynamic and oxygen transport variables.

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Main Results:

  • Survivors demonstrated progressively higher cardiac index, oxygen delivery (DO2), and oxygen consumption (VO2) compared to nonsurvivors.
  • Early transient reductions in VO2 preceded temperature increases and blood pressure drops in both groups.
  • While most patients were hyperdynamic, transient hypodynamic episodes occurred in a small percentage of measurements.

Conclusions:

  • Elevated cardiac index and DO2 are compensatory mechanisms for circulatory deficits limiting VO2.
  • Survivors maintain supranormal levels of cardiac index, DO2, and VO2.
  • Therapeutic targets should include increasing cardiac index (>5.5 L/min/m2), DO2 (>1000 mL/min/m2), and VO2 (>190 mL/min/m2) based on survivor patterns.