Shock Syndromes I

Learning Objectives

Distinguish between the various shock syndromes

on the basis of a patient’s clinical and hemodynamic

parameters.

devices and markers of perfusion.

Devise a treatment strategy for when to use intra-

venous fluids and/or vasopressors in a patient with

shock.

Develop a treatment pathway for the care of patients

with sepsis or septic shock that incorporates current

evidence and the Surviving Sepsis Campaign guide-

line recommendations.

Arginine vasopressin

Cao2

Arterial oxygen content

CO

Cardiac output

CVP

Central venous pressure

Do2

Oxygen delivery

Hgb

Hemoglobin

ICU

Intensive care unit

IVC

Inferior vena cava

LV

Left ventricular

time integral

MAP

Mean arterial pressure

O2ER

Oxygen extraction ratio

PAC

Pulmonary artery catheter

Pco2

Partial pressure of carbon dioxide

PCWP

Pulmonary capillary wedge pressure

PH

Pulmonary hypertension

PLR

Passive leg raising (test)

PPV

Pulse pressure variation

PRBC

Packed red blood cell

PVR

Pulmonary vascular resistance

RV

Right ventricular

SBP

Systolic blood pressure

SCr

Serum creatinine

Scvo2

Central venous oxygen saturation

SOFA

Sequential Organ Failure Assessment

SSC

Surviving Sepsis Campaign

Sto2

Tissue oxygen saturation

SV

Stroke volume

Svo2

Venous oxygen saturation

SVR

Systemic vascular resistance

SVV

Stroke volume variation

Vo2

Oxygen consumption

Self-Assessment Questions

Answers and explanations to these questions may be

found at the end of this chapter.

Questions 1 and 2 pertain to the following case.

An 80-year-old woman presents to the intensive care

unit (ICU) with septic shock caused by an Escherichia

coli urinary tract infection. Pertinent vital signs on

admission are as follows: blood pressure 80/40 mm

Hg, heart rate 155 beats/minute with a rhythm of atrial

fibrillation, respiratory rate 26 breaths/minute, and tem-

perature 105.8°F (41°C). On physical examination, the

patient is weak, lethargic, and confused. Pertinent labo-

ratory values are as follows: sodium (Na) 155 mEq/L,

potassium (K) 3.6 mEq/L, serum creatinine (SCr) 1.8

mg/dL, and lactate 4.2 mmol/L.

Which clinical symptoms and physiologic variables

most likely indicate that this patient has a shock

syndrome?

impaired oxygen delivery (Do2) to the patient’s end

organs?

A 62-year-old woman (weight 119 kg) develops

ventilator-associated pneumonia in the setting of

prolonged intubation after aortic valve replacement

surgery. Her pneumonia is complicated by septic

shock, and she is given 2 L of 0.9% sodium chloride

and 1 L of 5% albumin for resuscitation and initi-

ated on norepinephrine. Her laboratory values are as

follows: Na 144 mEq/L, chloride (Cl) 110 mEq/L,

K 3.8 mEq/L, bicarbonate 18 mEq/L, SCr 1.8 mg/

dL, arterial pH 7.28, and albumin 3.2 g/dL. Having