Clinical pathology of the shock syndromes

Abstract

The clinical aspects of shock syndromes are described from their inception as compensated physiology to a stage of decompensation. The clinical significance of hypotension, fluid-responsive and non fluid-responsive hypotension, is discussed. Untimely or inadequate treatment leads to persistent subclinical shock despite adjustments of the macrohemodynamic variables, which evolves in a second hit of physiological deterioration if not aggressively managed. Irreversible shock ensues as consequence of direct hit or as result of inadequate or delayed treatment and is characterized by drug-resistant hypotension.

Monitoring peripheral perfusion in critically ill patients at the bedside

“…It is well known that inadequate systemic circulation in both hypodynamic and hyperdynamic shock states can be accompanied by impaired peripheral circulation [4]. These abnormalities can be determined noninvasively using simple clinical assessments [5], skin temperature measurements [5], and optical monitoring devices [6,7].…”

Urgent Ultrasound Guided Hemodynamic Assessments by a Pediatric Medical Emergency Team: A Pilot Study

“…This likely contributed to the moderate agreement between raters in USCOM-derived classification of hemodynamic status. We used a limited number of key USCOM parameters to categorize hemodynamic status, which we felt were pragmatic [35], [36]. Including additional indices such as stroke volume responsiveness and Smith-Madigan Inotropy Index may have added supportive data to the assessments; however, the required software and pediatric reference ranges had not been validated at the time of our study.…”

“…Hemodynamic status was assessed in the context of abnormal vital signs, with the understanding that MAP may be normal in compensated shock, and heart rate and blood pressure may be elevated due to non-circulatory causes [35], [36]. MAP indicates mean arterial pressure; HR, heart rate; CI, cardiac index; SVRI, systemic vascular resistance index; SV, stroke volume.…”

Дослідження Центральної Та Периферичної Гемодинаміки У Дітей Із Сепсисом За Допомогою Ехокардіографії Та Ультразвукової Допплерографії

“…З боку периферичної гемодинаміки, за нашими результатами, найбільш значущими щодо діагностики септичного шоку виявилися показники периферичного опору в черевному стовбурі, нирковій та верхній мезентеріальній артеріях. Відповідно до загальноприйнятої концепції, розвиток септичного шоку супроводжується компенсаторною централізацією кровообігу за рахунок спазму периферичних судин для забезпечення циркуляції в життєво важливих органах [20].…”