Septic Shock Syndrome

Septic shock is defined as dangerously low blood pressure as a result of severe sepsis, an infection of an organ system or the blood. It is the most common cause of death in intensive care units and has been increasing in prevalence since the 1970s, as at-risk groups have grown larger.

Causes

• Sepsis is caused by a bacterial or fungal infection that causes an adverse response from at least one body system, sometimes after having entered the blood. Bacterial toxins often contribute to the eventual failure of organ systems. Septic shock is an advanced stage of sepsis, in which organ systems have already started shutting down.

  Widespread infection usually comes from untreated wounds, buildup of bacteria on catheters or other implants, as complications of other diseases, or as an opportunistic infection from surgery or in patients with a decreased immune response.

Symptoms

• The symptoms are: fever or unusually low body temperature, increased heart rate with low blood pressure, hyperventilation, confusion or disorientation, nausea and vomiting, diarrhea, skin lesions and/or tissue death in extremities.

Complications

• Septic shock causes major complications in several organ systems.

  Complications of the urinary system include kidney failure, protein or excesses of nitrogen in the urine, decrease in urine output and sudden jaundice.

  Respiratory system-related complications include water in the lungs; acute respiratory distress, in which the patient has sudden difficulty breathing; and abnormal levels of oxygen or carbon dioxide in the blood.

  Complications of the circulatory system include coagulopathy, a disorder of the blood that prevents it from clotting properly, and decreased heart function.

Diagnosis

• In suspected cases of sepsis, blood tests are taken to determine whether there are bacteria in the bloodstream. In up to 60 percent of cases, however, tests are negative and doctors must make a diagnosis based on symptoms present. Other blood, urine and mucous test results may indicate sepsis, including a high white blood cell count, low platelets, high lactate levels, or hypoglycemia (low blood sugar).

  Septic shock is diagnosed when a patient with severe sepsis suffers from low blood pressure even after his blood volume has been increased by medical intervention.

Treatment

• Treatment in sepsis and septic shock varies widely, according to symptoms present, the source of the initial infection, how long the patient has been septic and other factors.

  Initial treatment for sepsis includes intravenously increasing blood volume and medication with one or more antibiotics, which begins before a definite diagnosis is made. Any identified infection sites are drained or removed if possible. If doctors are able to determine a single bacteria or fungus responsible for the infection from blood cultures, the broad spectrum antibiotics are discontinued in favor of the most effective antibiotic versus the specific pathogen.

  In severe sepsis or once septic shock has developed, a patient receives medication to stabilize her blood pressure, blood sugar and blood oxygen levels. Steroid therapy is also common.

Risk Factors

• There are more than 700,000 cases of septic shock in the United States per year. Twenty percent to 30 percent of patients with severe sepsis and 40 percent to 60 percent of patients with septic shock die in the first month. The likelihood of survival is dependent on the original source of infection and overall health of the patient; individuals with chronic diseases are more likely to die from septic shock.

  Populations most at risk include newborns, the elderly, individuals with depressed immune systems (from disease or medication), patients with other infectious diseases, patients undergoing invasive procedures, patients on mechanical ventilation and individuals with artificial implants (such as pacemakers).