Brief overview
- Symptoms: Very low blood pressure (hypotension), fever or hypothermia, hyperventilation, in the further course organ failure.
- Course and prognosis: health deteriorates rapidly, immediate medical attention is needed
- Diagnosis and treatment: review of SOFA or qSOFA criteria, immediate stabilization of blood pressure by hydration and vasopressor therapy, antibiotic therapy, cause treatment (e.g., removal of catheters, tubes, prostheses, etc.), additional measures such as blood glucose control
- Causes and risk factors: always preceded by sepsis, often caused by hospital germs, rarely by fungi; occurs mostly in immunocompromised, young and elderly persons and pregnant women
- Prevention: There are hardly any preventive measures outside the hospital; sepsis should be diagnosed and treated as early as possible to prevent septic shock.
What is 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 type of illness – depending on the type of infection and the site of infection)
As sepsis progresses and septic shock begins, additional symptoms include:
- Confusion or impaired consciousness
- @ Poor general condition (decreased vigilance)
- Drop in blood pressure
- Cool and pale skin, especially on the hands and feet – later also blue discoloration of the skin (cyanosis) with marbling
What are the chances of survival in septic shock?
The messenger substances of the immune system additionally dilate the vessels in an attempt to continue supplying 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. Thus, in septic shock, there is a sharp drop in blood pressure that quickly assumes life-threatening proportions. In the course of septic shock, the patient’s health deteriorates very rapidly within days. Early treatment is therefore vital.
Prognosis in septic shock
People who survive septic shock often suffer long-term damage, for example due to the undersupply of particularly sensitive organs. However, this depends on the organs affected and on how severe the septic shock ultimately was. It also depends on how well the affected person responds to treatment.
How is septic shock diagnosed and treated?
Diagnosis
Because septic shock is due to previous sepsis, diagnosis is also made using the sequential organ failure assessment score (SOFA) or the rapid SOFA score (qSOFA). The qSOFA score is most appropriate in patients who are not in the ICU 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
Septic shock is considered confirmed when 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 urination (oliguria) in renal failure or dyspnea in pulmonary failure
Treatment for septic shock
In septic shock, the physician treats the general signs of sepsis, stabilizes blood pressure and the pumping function of the heart so that all organs continue to receive an adequate supply of blood.
So-called vasopressor (vasoconstrictor) substances such as epinephrine or norepinephrine or vasopressin increase blood pressure when it has dropped due to septic shock.
Antibiotic therapy, used as early as possible, serves to strengthen the body’s immune defenses and push back the infection caused by pathogens. Ideally, the pathogen can be identified through blood tests and tissue examinations. This helps to select the most suitable antibiotics. Therapy is then more targeted and effective.
Other supportive measures include regulating blood sugar levels with the help of insulin, since elevated blood sugar weakens the immune defense. In addition, patients who continue to suffer from low blood pressure (hypotension) are also given corticosteroids (cortisol, cortisone). They help to raise the low blood pressure.
What are causes and risk factors?
- Diabetes mellitus
- Liver disease
- Diseases of the urinary/genital tract
- catheters, implants, stents or prostheses
- recent surgical procedures
- immunodeficiency (HIV/AIDS)
- blood cancer (leukemia)
- long-term use of chemotherapeutic agents, antibiotics or cortisone preparations
- very young as well as old people and pregnant women
The pathogens usually enter the body through the lungs, urinary tract, gallbladder, and digestive tract, from where they travel through the blood to all parts of the body.
The exact disease process of septic shock is not yet fully understood. As in sepsis, there is an increased defense reaction in which the body sends out numerous substances called inflammatory factors such as cytokines, interleukins, leukotrienes, histamine, serotonin, and defense cells (leukocytes) to fight the pathogen. Clotting, for example, is increased by this reaction, which is why small blood clots form more frequently.
How can septic shock be prevented?
To prevent septic shock, the first thing to do is to prevent blood poisoning. Sepsis that develops outside of a hospital stay is difficult to prevent. However, general hygiene measures such as washing hands and food help to minimize the risk.
For injuries with open wounds, affected individuals should thoroughly clean and dress the wound with clean water to prevent re-contamination and infection with pathogens. It is also advisable to take advantage of vaccinations to protect against infection and to consult a doctor if an illness with a pathogen is suspected.
From the physicians’ side, comprehensive education about infectious diseases that carry an increased risk of sepsis is very helpful, as is a comprehensive range of vaccinations. Good education is very important, especially in high-risk groups.
If a case of septic shock occurs, the highest priority is to minimize the risk of death. This can be achieved by a precise analysis of the clinical picture, careful diagnosis and intensive treatment as early as possible.