Parameters for hemodynamic support of sepsis in adult patients: 2004 updateErwin Pradian

Bagian Anestesiologi dan Reanimasi Fakultas Kedokteran Universitas Padjadjaran/ Perjan RS. dr. Hasan Sadikin Bandung

Shock

occurs when circulatory system fails to maintain adequate cellular per-fusion.Syndrome that may arise from any of several ini-tiating causes: symptoms, signs, and laboratory ab-normalities hypoperfu-sion emerges.

Septic shockResult when infectious agents or infection-induced mediators in the bloodstream produce hemodynamic decompensation.Primarily a form of distributive shock.A complex reaction between pathologic vasodilation, relative and absolute hypovolemia, myocard dysfunction, and altered blod flow distribution occurs due to the inflammatory response to infection.Even after the restoration of intravascular volume, microcirculatory abnormalities may persist and lead to maldistribution of cardiac output.

Septic shockCellular dysfunction final outcome with multiple stimuli, eg:- cellular ischemia.- disruption of cellular metabolism- free radicalcaspases activation, HSP induction may lead to apoptotic cell death.

vvvCo-activatedphospholipaseXATPATPATPMembranelipidsFree Fatty Acids(Arachidonic acids)ProstaglandinsThromboxaneLeukotrinesFree radicalsFree radicalsCaCaCaCaCaCaCaCaNaKNaNaNaNaKKKNeurotransmitter gate channelVoltage sensitive channel

Therapy of Septic Shock3 main components:Maintain a reasonable MAP & CO.Identified & eliminated nidus of infection using antimicrobial drugs and surgical drainage whenever indicated.Interrupt the pathogenic sequence leading to septic shock.