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Septic Shock in Humans
Advances in the Understanding of Pathogenesis, Cardiovascular Dysfunction, and Therapy
- Joseph E. Parrillo, MD;
- Margaret M. Parker, MD;
- Charles Natanson, MD;
- Anthony F. Suffredini, MD;
- Robert L. Danner, MD;
- Robert E. Cunnion, MD; and
- Frederick P. Ognibene, MD
Abstract
Septic shock is the commonest cause of death in intensive care units. Although sepsis usually produces a low systemic vascular resistance and elevated cardiac output, strong evidence (decreased ejection fraction and reduced response to fluid administration) suggests that the ventricular myocardium is depressed and the ventricle dilated. In survivors, these abnormalities are reversible. Failure to develop ventricular dilatation in nonsurvivors suggests that dilatation is a compensatory mechanism needed to maintain adequate cardiac output. With a canine model of septic shock that is very similar to human sepsis, myocardial depression was confirmed using load-independent measures of ventricular performance. Endotoxin administration to humans simulates the qualitative, cardiovascular abnormalities of sepsis. The pathogenesis of septic shock is extraordinarily complex. Diverse microorganisms can generate toxins, stimulating release of potent mediators that act on vasculature and myocardium. A circulating myocardial depressant substance has been closely associated with the myocardial depression of human septic shock. Therapy has emphasized early use of antibiotics, critical care monitoring, aggressive volume resuscitation, and, if shock continues, use of inotropic agents and vasopressors. Pharmacologic or immunologic antagonism of endotoxin or other mediators may prove to enhance survival in this highly lethal syndrome.
Article and Author Information
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An edited summary of a Combined Clinical Staff Conference held 25 January 1989 at the Clinical Center, National Institutes of Health, Bethesda, Maryland. The conference was sponsored by the Clinical Center, National Institutes of Health, U.S. Department of Health and Human Services.
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Authors who wish to cite a section of the conference and specifically indicate its author can use this example for the form of reference:
Parker MM. Cardiac dysfunction in human septic shock, pp 229-230. In: Parrillo JE, moderator. Septic shock in humans: advances in the understanding of pathogenesis, cardiovascular dysfunction, and therapy. Ann Intern Med. 1990;113:227-242.
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Requests for Reprints: Joseph E. Parrillo, MD, Rush-Presbyterian-St. Luke's Medical Center, 1653 West Congress Parkway, Chicago, IL 60612.
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Current Author Addresses: Dr. Parrillo: Rush-Presbyterian-St. Luke's Medical Center, 1653 West Congress Parkway, Chicago, IL 60612. Drs. Parker, Natanson, Suffredini, Danner, Cunnion, and Ognibene: National Institutes of Health, Building 10, Room 10-D-48, Bethesda, MD 20892.
