Intensive Care Medicine

, Volume 42, Issue 12, pp 2077–2079 | Cite as

Understanding circulatory failure in sepsis

  • Andreas Bloch
  • David Berger
  • Jukka TakalaEmail author
Understanding the Disease


Septic shock or acute circulatory failure in sepsis causes a mismatch between tissue perfusion and metabolic demands. The heart, the vasculature and alterations in various tissue and cellular functions are involved in the pathophysiology. The clinical presentation can be highly variable, changes over time and is modified by preceding and concomitant treatment and comorbidities. The clinical hallmarks of septic shock are signs of tissue hypoperfusion, hypotension or need for vasopressors to prevent hypotension, despite adequate fluid resuscitation. Signs of tissue hypoperfusion vary and can include impaired capillary perfusion, oliguria, elevated blood lactate and altered mentation. The blood pressure level that is clinically relevant varies between patients, and “adequate” fluid resuscitation is highly subjective. Therefore, septic shock defies explicit, objective definitions, as shown by the current debate around attempts to define it [1, 2]. Nevertheless, increasing...


Septic Shock Stressed Volume Right Ventricular Venous Return Pulse Pressure Variation 
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Compliance with ethical standards

Conflicts of interest

The authors do not have any conflict of interest regarding this article.


  1. 1.
    Singer M, Deutschman CS, Seymour CW, Shankar-Hari M, Annane D, Bauer M et al (2016) The third international consensus definitions for sepsis and septic shock (sepsis-3). JAMA 315:801–810CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Makam AN, Nguyen O (2016) Clinical criteria to identify patients with sepsis. JAMA 316:453CrossRefPubMedGoogle Scholar
  3. 3.
    Dunser MW, Takala J, Ulmer H, Mayr VD, Luckner G, Jochberger S et al (2009) Arterial blood pressure during early sepsis and outcome. Intensive Care Med 35:1225–1233CrossRefPubMedGoogle Scholar
  4. 4.
    Correa TD, Vuda M, Blaser AR, Takala J, Djafarzadeh S, Dunser MW et al (2012) Effect of treatment delay on disease severity and need for resuscitation in porcine fecal peritonitis. Crit Care Med 40:2841–2849CrossRefPubMedGoogle Scholar
  5. 5.
    Berlin DA, Bakker J (2014) Understanding venous return. Intensive Care Med 40:1564–1566CrossRefPubMedGoogle Scholar
  6. 6.
    Parker MM, Shelhamer JH, Bacharach SL, Green MV, Natanson C, Frederick TM et al (1984) Profound but reversible myocardial depression in patients with septic shock. Ann Intern Med 100:483–490CrossRefPubMedGoogle Scholar
  7. 7.
    Suffredini AF, Fromm RE, Parker MM, Brenner M, Kovacs JA, Wesley RA et al (1989) The cardiovascular response of normal humans to the administration of endotoxin. New Engl J Med 321:280–287CrossRefPubMedGoogle Scholar
  8. 8.
    Vieillard-Baron A, Prin S, Chergui K, Dubourg O, Jardin F (2003) Hemodynamic instability in sepsis: bedside assessment by Doppler echocardiography. Am J Respir Crit Care Med 168:1270–1276CrossRefPubMedGoogle Scholar
  9. 9.
    Bouhemad B, Nicolas-Robin A, Arbelot C, Arthaud M, Feger F, Rouby JJ (2008) Isolated and reversible impairment of ventricular relaxation in patients with septic shock. Crit Care Med 36(3):766–774CrossRefPubMedGoogle Scholar
  10. 10.
    Landesberg G, Gilon D, Meroz Y, Georgieva M, Levin PD, Goodman S et al (2012) Diastolic dysfunction and mortality in severe sepsis and septic shock. Eur Heart J 33:895–903CrossRefPubMedGoogle Scholar
  11. 11.
    Daudel F, Tüller D, Krähenbuhl S, Jakob SM, Takala J (2010) Pulse pressure variation and volume responsiveness during acutely increased pulmonary artery pressure: an experimental study. Crit Care 14:R122CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Vieillard-Baron A, Cecconi M (2014) Understanding cardiac failure in sepsis. Intensive Care Med 40:1560–1563CrossRefPubMedGoogle Scholar
  13. 13.
    Guarracino F, Ferro B, Morelli A, Bertini P, Baldassarri R, Pinsky MR (2014) Ventriculoarterial decoupling in human septic shock. Crit Care 18:R80CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Morimont P, Lambermont B, Ghuysen A, Gerard P, Kolh P, Lancellotti P et al (2008) Effective arterial elastance as an index of pulmonary vascular load. Am J Physiol Heart Circ Physiol 294:H2736–H2742CrossRefPubMedGoogle Scholar
  15. 15.
    Dunser MW, Takala J, Brunauer A, Bakker J (2013) Re-thinking resuscitation: leaving blood pressure cosmetics behind and moving forward to permissive hypotension and a tissue perfusion-based approach. Crit Care 17:326CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg and ESICM 2016

Authors and Affiliations

  1. 1.Department of Intensive Care MedicineInselspital, Bern University Hospital, University of BernBernSwitzerland

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