The modern treatment of shock based on physiologic principles

Abstract

The hemodynamic disturbances resulting from shock due to hemorrhage or endotoxins and the results of several methods of treatment are presented. The experimental data indicate that vasopressors intensify the visceral vasoconstriction, ischemia, and loss of capillary integrity characteristic of severe shock. The benefical effects of corticosteroids or phenoxybenzamine combined with volume replacement are indicated. The hemodynamics of shock appear to be similar in man and animals, although the visceral organ which suffers the greatest insult varies among the species. This concept of a basic hemodynamic mechanism of shock gains further support from the fact that the same therapy in dog and man produces similar results. In treating patients with actual or suspected bacterial shock, we prefer a regimen of hydrocortisone, plasma to replace volume loss, specific antibiotic therapy, and surgical intervention when necessary to eliminate the source of infection. Hydrocortisone is used in preference to phenoxybenzamine because it has a more subtle effect on vascular tone and is less likely to cause further hypotension. Plasma is preferred to low molecular dextr~n because of our concern over the combined effects of endotoxin shock and dextran on basic blood clotting mechanisms in man.A patient pursuit of facts, and cautious combination and comparison of them, is the drudgery to which man is subjected by his Maker, if he wishes to attain sure knowledge.In the past half century, there has been remarkable progress in our knowledge and ability to treat traumatic shock. No doubt,

Effects of Hypothermia on Rat Reticuloendothelial Blood Clearance and Particulate Uptake

“…Shock induced by a variety of insults (2,(9)(10)(11)15,16,20), to include hyperthermic shock (3,5,7,8) is known to influence RES function. However, a paucity of information is available in regards to hypothermic effects on the RES.…”

“…The considerable influence of the reticuloendothelial system (RES) on recovery following trauma and/or vascular shock (1)(2)(3)(4)(5)(7)(8)(9)(10)(11)15,16,20) supports a concept that RES fitness is an important survival factor following physiological stress associated with significant tissue injury. Findings from USARIEM suggest this concept is relevant in heat stress survival, as well.…”

“…This system is known to influence survival following vascular shock and/or tissue injury induced by hemorrhage (9)(10)(11)20), endotoxin (10,15,16,20), epinephrine (11), trauma (2,20), acceleration (15), tourniquet occlusion (16) or heat stress (3)(4)(5)7,8). Furthermore, shock susceptibility is increased by RES blockade (2,7,10,16,20).…”

Corticosteroid Therapy in Regional Small Bowel Ischaemia

“…Altura & Altura (1) claim that in these doses corticosteroids unspecifically inhibit the effect of vasoconstriction that may be released in intestinal ischaemia. Lillehei et al (12) assumed that corticosteroids act as alpha receptor blocking agents but provided no definite evidence for this assumption. Bruns & Connolly (3), on the other hand, considered that the effect was a potentiation of the vasoconstrictive action of the catecholamines.…”

Biochemical Changes in Shock

“…Metabolic acidosis is not invariable, and respiratory alkalosis sometimes occurs. There is increased secretion of cortisol (Melby and Spink, 1958) together with high blood catecholamines, which are believed by some authors to contribute to irreversibility (Lillehei et al, 1964). Renal failure and liver dysfunction may further complicate the picture, and there are alterations in blood clotting factors, and many other biochemical changes of less obvious clinical significance, reviews of which have appeared recently (Hershey, 1964).…”