Septic shock  

Cause

Septic shock is characterized by a very severe drop in blood pressure in severe sepsis despite sufficient fluid supply. This requires immediate therapy with so-called vasopressor drugs, which constrict the vessels. Increased lactate levels in the blood (hyperlactatemia) are also characteristic of septic shock.

How does septic shock manifest itself?

At the beginning of the disease there are the typical symptoms of sepsis:

• Mostly fever
• Accelerated heartbeat (tachycardia) with still normal blood pressure
• Signs of infection (redness, hyperthermia, swelling, nausea, vomiting, etc. - depending on the type of infection and the site of infection)

As the sepsis progresses and septic shock begins, further symptoms appear:

• Confusion or impaired consciousness
• Poor general condition (reduced vigilance)
• Drop in blood pressure
• Cool and pale skin, especially on the hands and feet - later also blue discolouration of the skin (cyanosis) with marbling.

What are the chances of survival in septic shock?

• Septic shock always occurs in conjunction with previous blood poisoning (sepsis). This means there is a pathogen that has reached the patient's bloodstream and against which the immune system has not been able to defend itself sufficiently. A misdirected and excessive inflammatory reaction throughout the body subsequently damages several vital organs.
• The messenger substances of the immune system additionally dilate the vessels in an attempt to continue to supply all organs and body tissues with an abundant supply of blood. A reaction that overtaxes the heart to this extent, because at the same time large quantities of blood remain in the body periphery - the arms and legs - and do not flow back to the heart. This is how septic shock leads to a severe drop in blood pressure, which quickly assumes life-threatening proportions. In the course of a septic shock, the health condition deteriorates very quickly within days. Early treatment is therefore vital.

Diagnosis

Since septic shock is due to previous sepsis, the diagnosis is also made here using the SOFA score (Sequential Organ Failure Assessment Score) or the rapid SOFA score (qSOFA). The qSOFA score is most suitable for patients who are not in intensive care and is based on mean arterial blood pressure, respiratory rate and the Glasgow Coma Scale (GCS):

• Respiratory rate ≥ 22breaths per minute.
• Impaired consciousness (GCS <15)
• Systolic blood pressure ≤ 100mmHg

If at least two of the criteria apply, there is a strong suspicion of sepsis. This usually leads doctors to clarify further clinical factors according to the SIRS criteria. For example, the heart rate (>90 beats/min), body temperature (>38 degrees Celsius or <36 degrees Celsius) and respiratory rate (>20 breaths/min) as well as the white blood cell count are checked.

Septic shock is confirmed if the following criteria are met:

• A mean arterial blood pressure of 65mmHg or less despite therapy with vasopressors.
• Serum lactate levels greater than 2mmol/l (>18mg/dl) that persist after adequate hydration.
• Signs of organ failure such as decreased urine output (oliguria) in renal failure or dyspnea in respiratory failure.

Treatment for septic shock

• In septic shock, the doctor treats the general signs of sepsis, stabilizes the blood pressure and the pumping function of the heart so that all organs continue to be supplied with sufficient blood.
• A high fluid intake via an infusion with a saline or crystalloid solution serves to keep the vessels in a filled state. This is important because the dilated vessels cause a lot of blood to pool in the arms, legs and distant tissues and not flow back to the heart fast enough. The supply of fluids supports the adequate supply of the organs and prevents the threat of organ failure. If the affected person suffers from severe shortness of breath, artificial respiration is often necessary at this point, or at least support for the oxygen supply via a mask or nasal tube.
• So-called vasopressor (vasoconstrictor) substances such as epinephrine or norepinephrine or vasopressin raise the blood pressure if it has dropped due to septic shock.
• Antibiotic therapy, which is used as early as possible, serves to strengthen the body's immune defense and to push back the infection caused by pathogens.
• Ideally, the pathogen can be identified through blood samples and tissue tests. This helps to select the most suitable antibiotics. The therapy is then more targeted and effective.
• Other supportive measures include regulating blood sugar levels with the help of insulin, as elevated blood sugar weakens the immune defense. In addition, patients who still suffer from low blood pressure (hypotension) are given corticosteroids (cortisol, cortisone). These help to raise the low blood pressure.