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Septic shock in critically ill patients: aetiology, management and outcome
N S Dahmash1, N H Chowdhury, D F Fayed
1Department of Pulmonary Critical Care Medicine, College of Medicine, King Khalid University Hospital, Riyadh, Saudi Arabia.
Abstract:
Over a period of 28 months, 45 episodes of septic shock from 83 episodes of bacteraemia were studied prospectively to evaluate their clinical profile, management and outcome. Thirty-six patients were studied, the overall incidence of septic shock being 54.2%. Gram-negative organisms accounted for 23 (51.1%) of such episodes, Gram-positive 17 (37.8%), and three episodes were polymicrobial (6.7%). The organisms isolated most frequently were Staphylococcus epidermidis (17.8%), Pseudomonas aeruginosa (13.3%), Escherichia coli and Klebsiella sp. (each 11.1%). Coagulation abnormalities were detected in 32 episodes (78%) and disseminated intravascular coagulation (DIC) occurred in 11 of these with high mortality. The most common underlying conditions were respiratory, hepatic and renal failures. The majority of these patients received crystalloids, colloids, vasopressor drugs and blood. Swan-Ganz catheters (SGC) were inserted on eight occasions, the majority of times indicating a hyperdynamic circulatory response. The overall mortality was 40%, despite aggressive management and intensive care. The most important factor in reducing mortality is early detection of bacteraemia and prompt management of these patients.
Insights
Early detection of bacteremia and prompt management are crucial for reducing mortality in septic shock patients. This study highlights key clinical profiles, common pathogens, and outcomes in 45 septic shock episodes.
Area of Science:
- Infectious Diseases
- Critical Care Medicine
- Clinical Microbiology
Background:
- Septic shock is a life-threatening condition characterized by circulatory dysfunction and organ hypoperfusion.
- Bacteremia, the presence of bacteria in the bloodstream, is a common precursor to septic shock.
Purpose of the Study:
- To prospectively evaluate the clinical profile, management strategies, and outcomes of septic shock episodes.
- To identify common causative organisms and associated underlying conditions in patients with septic shock.
Main Methods:
- Prospective study of 45 septic shock episodes over 28 months in 36 patients.
- Analysis of clinical data, causative microorganisms, coagulation abnormalities, and management interventions.
- Inclusion of Swan-Ganz catheter data to assess circulatory response.
Main Results:
- Overall incidence of septic shock was 54.2% of bacteremia episodes.
- Gram-negative organisms (51.1%) and Gram-positive organisms (37.8%) were primary causes.
- Coagulation abnormalities, including disseminated intravascular coagulation (DIC), were frequent (78%), associated with high mortality.
- Common underlying conditions included respiratory, hepatic, and renal failures.
- Despite intensive care, overall mortality was 40%.
Conclusions:
- Early detection of bacteremia and prompt, aggressive management are critical for improving septic shock outcomes.
- Understanding the clinical profile and common pathogens aids in targeted therapeutic interventions.
- Coagulation abnormalities, particularly DIC, are significant predictors of mortality in septic shock.