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The Pathophysiology of Shock

  • Chapter
Care of the Critically Ill Patient

Abstract

Circulatory shock is a common and important problem. Often shock has developed in patients as a consequence of multi-organ trauma or as a consequence of complications arising from the treatment of an underlying disease. The purpose of this chapter is to detail the current understanding about the pathophysiology of circulatory shock. Because of the heterogeneity of shock states and the difficulty in studying critically ill patients, much of the information presented is derived from experimental studies.

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References

  1. Abe S, Gatanga M, Yamazaki G et al. (1985) Purification of rabbit tumor necrosis factor. FEBS Lett 180: 203–206

    Article  PubMed  CAS  Google Scholar 

  2. Altura BM, Lefer AM, Schumer W (1983) Historical perspectives of shock. In: Altura BM, Lefer AM, Shumer W (eds) Handbook of shock and trauma. Vol 1: Basic science. Raven Press, New York, pp 1–2

    Google Scholar 

  3. Archer LT (1985) Myocardial dysfunction in endotoxin- and E.coli-induced shock: pathophysiological mechanisms. Circ Shock 15: 261–280

    PubMed  CAS  Google Scholar 

  4. Armstrong RA, Jones RL, Wilson NH (1985) Effect of thromboxane receptor antagonist EP 092 on endotoxic shock in sheep. Prostaglandins 29: 703–713

    Article  PubMed  CAS  Google Scholar 

  5. Bernton EW, Long JB, Holaday JW (1985) Opioids and neuropeptides: mechanisms in circulatory shock. Fed Proc 44: 290–299

    PubMed  CAS  Google Scholar 

  6. Bertolini A, Guarini S, Ferrari W et al. (1987) ACTH-(1–24) restores blood pressure in acute hypovolaemia and haemorrhagic shock in humans. Eur J Clin Pharmacol 32: 537–538

    Article  PubMed  CAS  Google Scholar 

  7. Beutler B, Cerami A (1986) Cachectin and tumor necrosis factor as two sides of the same biological coin. Nature 320: 584–588

    Article  PubMed  CAS  Google Scholar 

  8. Beutler B, Milsark IW, Cerami AC (1985) Passive immunization against cachectin/tumor necrosis factor. Science 229: 869–871

    Article  PubMed  CAS  Google Scholar 

  9. Bolton TB (1979) Mechanisms of action of transmitters and other substances on smooth muscle. Physiol Rev 59: 606–718

    PubMed  CAS  Google Scholar 

  10. Bulkley GB, Oshima A, Bailey RM (1986) Pathophysiology of hepatic ischemia in cardiogenic shock. Am J Surg 151: 87–97

    Article  PubMed  CAS  Google Scholar 

  11. Carr DB, Bergland R, Hamilton A et al. (1982) Endotoxin stimulated opioid peptide secretion: two secretory pools and feedback control in vivo. Science 217: 845–848

    Article  PubMed  CAS  Google Scholar 

  12. Carswell EA, Old LJ, Kassel RL et al. (1975) An endotoxin-induced serum factor that causes necrosis of tumors. Proc Natl Acad Sci USA 72: 3666–3670

    Article  PubMed  CAS  Google Scholar 

  13. Chernow B, Roth BL (1985) Pharmacologic support of the cardiovasculature in septic shock. In: Sprung C, Sibbald W (eds) New horizons: focus on septic shock. Society of Critical Care Medicine, Fullerton, California

    Google Scholar 

  14. Chernow B, Roth BL (1986) Pharmacologic manipulation of the peripheral vasculature in shock: clinical and experimental approaches. Circ Shock 18: 141–155

    PubMed  CAS  Google Scholar 

  15. Chernow B, Lake CR, Zaloga GP et al. (1983) Effect of clonidine on sympathetic nervous system activity in patients with essential hypertension. Int J Clin Pharmacol Res 3: 9–15

    PubMed  CAS  Google Scholar 

  16. Chernow B, Lake CR, Barton M et al. (1984) Sympathetic nervous system sensitivity to hemorrhagic hypotension in the subhuman primate. J Trauma 24: 229–232

    Article  PubMed  CAS  Google Scholar 

  17. Chernow B, Lake, CR, Teich S et al. (1986a) Hemorrhagic hypotension increases plasma beta-endorphin concentrations in the nonhuman primate. Crit Care Med 14: 505–507

    Article  PubMed  CAS  Google Scholar 

  18. Chernow B, Reed L, Geelhoed GW et al. (1986b) Glucagon: endocrine effects and calcium involvement in cardiovascular actions in dogs. Circ Shock 19: 393–407

    PubMed  CAS  Google Scholar 

  19. Chernow B, Zaloga GP, Malcolm D et al. (1987) Glucagon’s chronotropic action is calcium dependent. J Pharmacol Exp Ther 241: 833–837

    PubMed  CAS  Google Scholar 

  20. Cook JA, Wise WC, Hulushka PV (1985) Protective effect of a selective leukotriene (LT) antagonist in endotoxic ( LPS) shock. Fed Proc 44: 1574

    Google Scholar 

  21. Cowley RA, Hankins JR, Jones RT et al. (1982) Pathology and pathophysiology of the liver. In: Cowley RA, Trump BF (eds) Pathophysiology of shock, anoxia, and ischemia. Williams & Wilkins, Baltimore, pp 285–301

    Google Scholar 

  22. Crile GW (1899) An experimental research into surgical shock. JB Lippincott, Philadelphia

    Google Scholar 

  23. Deby-DuPont G, Rodoux L, Mass M et al. (1982) Release of thromboxane B2 during adult respiratory distress syndrome and its inhibition by nonsteroidal antiinflammatory substance in man. Arch Int Pharmacodyn Ther 259: 317–319

    PubMed  CAS  Google Scholar 

  24. Dinarello CA (1984) Interleukin-1. Rev Infect Dis 6: 51–95

    Article  CAS  Google Scholar 

  25. Faist AE, Baue AE, Dittmer H et al. (1983) Multiple organ failure in polytrauma patients. J Trauma 23: 775–787

    Article  PubMed  CAS  Google Scholar 

  26. Farrar WL, Mizel SB, Farrar JJ (1980) Participation of lymphocyte activating factor (interleukin-1) in the induction of cytotoxic T cell responses. J Immunol 124: 1371–1377

    PubMed  CAS  Google Scholar 

  27. Feuerstein G, Hallenbeck JM (1987) Prostaglandins, leukotrienes, and platelet-activating factor in shock. Ann Rev Pharmacol Toxicol 27: 301–313

    Article  CAS  Google Scholar 

  28. Filkins JP (1984) Reticuloendothelial system function and glucose-insulin dyshomeostasis in sepsis. Am J Emerg Med 2: 70–73

    Article  PubMed  CAS  Google Scholar 

  29. Filkins JP (1985) Monokines and the metabolic pathophysiology of septic shock. Fed Proc 44: 300–304

    PubMed  CAS  Google Scholar 

  30. Fitz-Gerald GA, Watkins J, Dollery CT (1981) Regulation of norepinephrine release by peripheral alpha-2 receptor stimulation. Clin Pharmacol Ther 29: 160–167

    Article  CAS  Google Scholar 

  31. Flynn JT (1984) Prostanoids and cell injury. Am J Emerg Med 2: 20–27

    Article  PubMed  CAS  Google Scholar 

  32. Gamble JR, Harlan JM, Klebanoff SJ, Vadas MA (1985) Stimulation of the adherence of neutrophils to umbilical vein endothelium by human recombinant tumor necrosis factor. Proc Natl Acad Sei USA 82: 8667–8671

    Article  CAS  Google Scholar 

  33. Ghosh S, Liu MS (1983) Changes in alpha adrenergic receptors in dog livers during endotoxic shock. J Surg Res 34: 239–245

    Article  PubMed  CAS  Google Scholar 

  34. Goldblum SE, Hennig B, Jay K et al. (1987) Tumor necrosis factor/cachectin ( TNF)-induced pulmonary vascular endothelial injury in rabbits. J Leukocyte Biol 42: 551

    Google Scholar 

  35. Hall-Boyer K, Zaloga GP, Chernow B (1984) Glucagon: hormone or therapeutic agent? Crit Care Med 12: 584–589

    Article  PubMed  CAS  Google Scholar 

  36. Hesse IFA, Johns EJ (1984) An in vivo study of the alpha-adrenoceptor subtypes on the renal vasculature of the anesthetized rabbit. J Auton Pharmacol 4: 145–152

    Article  PubMed  CAS  Google Scholar 

  37. Hock CE, Lefer AM (1984) Beneficial effect of thromboxane synthetase inhibitor in traumatic shock. Circ Shock 14: 159–168

    PubMed  CAS  Google Scholar 

  38. Hock CE, Loprest L, Lefer AM (1984) Inhibitors of lipoxygenase products improve survival in traumatic shock. Prostaglandins 28: 557–571

    Article  PubMed  CAS  Google Scholar 

  39. Holaday JW (1984) Opiate antagonists in shock and trauma. Am J Emerg Med 2: 8–12

    Article  PubMed  CAS  Google Scholar 

  40. Holaday JW, Faden AJ (1978) Naloxone reversal of endotoxin hypotension suggests role of endogenous endorphins in shock. Nature 275: 450–451

    Article  PubMed  CAS  Google Scholar 

  41. Holaday JW, Malcolm DS (1988) Endogenous opioids and other peptides: evidence for their clinical relevance in shock and CNS injury. In: Chernow B (ed) The pharmacologic approach to the critically ill patient. Williams & Wilkins, Baltimore, pp 718–732

    Google Scholar 

  42. Holaday JW, O’Hara M, Faden AI (1981) Hypophysectomy alters cardiorespiratory variables: central effects of pituitary endorphins in shock. Am J Physiol 241: H479 - H485

    PubMed  CAS  Google Scholar 

  43. Holaday JW, D’Amato RJ, Ruvio BA et al. (1983) Adrenalectomy blocks pressor responses to naloxone in endotoxic shock: evidence for sympathomedullary in-volvement. Circ Shock 11: 201–210

    PubMed  CAS  Google Scholar 

  44. Kawakami M, Pekala PH, Lane MD, Cerami A (1982) Lipoprotein lipase suppression in 3T3-L1 cells by an endotoxin-induced mediator from exudate cells. Proc Natl Acad Sei USA 79: 912–916

    Article  CAS  Google Scholar 

  45. Langer SZ, Shepperson NB (1982a) Postjunctional alpha-1 and alpha-2 adrenoceptors: preferential innervation of alpha-1 adrenoceptors and the role of neuronal uptake. J Cardiovasc Pharmacol 4: S8 - S13

    Article  PubMed  Google Scholar 

  46. Langer SZ, Shepperson NB (1982b) Recent developments in vascular smooth muscle pharmacology: the postsynaptic alpha-2 adrenoceptor. Trends Pharmacol Sei 3: 440–444

    Article  CAS  Google Scholar 

  47. Lefer AM (1978) Properties of cardioinhibitory factors produced in shock. Fed Proc 37: 2734–2740

    PubMed  CAS  Google Scholar 

  48. Lefer AM (1985) Eicosanoids as mediators of ischemia and shock. Fed Proc 44: 275–280

    PubMed  CAS  Google Scholar 

  49. Lefer AM (1986) Leukotrienes as mediators of ischemia and shock. Biochem Pharmacol 35: 123–127

    Article  PubMed  CAS  Google Scholar 

  50. Lefer AM (1987) Physiologic and pathophysiologic role of cyclo-oxygenase metabolites of arachidonic acid in circulatory disease states. Cardiovas Clin 18: 85–99

    CAS  Google Scholar 

  51. Legan E, Chernow B, Parrillo J et al. (1985) Activation of phosphatidylinositol turnover in rat aorta by alpha-1- adrenergic receptor stimulation. Eur J Pharmacol 110: 389–390

    Article  PubMed  CAS  Google Scholar 

  52. Lux WE Jr, Feuerstein G, Faden AI (1983) Thyrotropin-releasing hormone reverses the hypotension and brady-cardia produced by leukotriene D4 in unanesthetized guinea pigs. Prostaglandins Leukotrienes Med 10:301 — 307

    Google Scholar 

  53. Metthay MA, Eschenbacker WL, Goetzel EJ (1984) Elevated concentrations of leukotriene D4 in pulmonary edema fluid of patients with adult respiratory distress syndrome. J Clin Immunol 4: 479–483

    Article  Google Scholar 

  54. McCallum RE (1981) Hepatocyte-Kupffer cell interactions in the inhibition of hepatic glrconeogenesis by bacterial endotoxin. In: Majde JA, Person RJ (eds) Pathophysiological effects of endotoxins at the cellular level. Liss, New York, pp 99–113

    Google Scholar 

  55. Mcintosh TK, Faden AI (1986) Thyrotropin-releasing hormone ( TRH) and circulatory shock. Circ Shock 18: 241–258

    Google Scholar 

  56. McMillan M, Chernow B, Roth BL (1986) Hepatic alpha-l-adrenergic alteration in a rat model of chronic sepsis. Circ Shock 19: 185–193

    PubMed  CAS  Google Scholar 

  57. Mittermayer C, Riede UN (1982) Human pathology of the gastro-intestinal tract in shock, ischemia and hypoxemia. In: Cowley RA, Trump BF (eds) Pathophysiology of shock, anoxia, and ischemia. Williams & Wilkins, Baltimore, pp 301–308

    Google Scholar 

  58. Montgomery SB, Jose PH, Slotkoff LM et al. (1980) The regulation of intrarenal blood flow in the dog during ischemia. Circ Shock 7: 71–82

    PubMed  CAS  Google Scholar 

  59. Murphy RA, Mras S (1983) Control of tone in vascular smooth muscle. Arch Intern Med 143: 1001–1006

    Article  PubMed  CAS  Google Scholar 

  60. Needleman P, Greenwald JE (1986) Atriopeptin: a cardiac hormone intimately involved in fluid, electrolyte, and blood-pressure homeostasis. N Engl J Med 314: 828–833

    Article  PubMed  CAS  Google Scholar 

  61. Needleman P, Kaley G (1978) Cardiac and coronary prostaglandin synthesis and function. N Engl J Med 298: 1122–1128

    Article  PubMed  CAS  Google Scholar 

  62. Ogletree MJ, Smith JB, Lefer AM (1978) Actions of prostaglandins on isolated perfused cat coronary arteries. Am J Physiol 235: H400 - H406

    PubMed  CAS  Google Scholar 

  63. Ogletree ML, Oates JA, Brigham KL et al. (1982) Evidence for pulmonary release of 5- hydroxyeicosatetraenoic acid (5-HETE) during endotoxemia in unanesthetized sheep. Prostaglandins 23: 459–468

    Article  PubMed  CAS  Google Scholar 

  64. Okusawa S, Ikejima T, Gelfand JA, Dinarello CA (1987) Synergism of interleukin-1 (IL-1) and tumor necrosis factor ( TNF) in the production of shock and its prevention by cyclooxygenase inhibition. J Leukocyte Biol 42: 552–553

    Google Scholar 

  65. Onesti G, Schwartz AB, Kim KE (1971) Antihypertensive effect of Clonidine. Circ Res 28 (Suppl 2): 53–69

    PubMed  Google Scholar 

  66. Parker JL, Adams HR (1985) Development of myocardial dysfunction in endotoxic shock. Am J Physiol 248: H818 - H826

    PubMed  CAS  Google Scholar 

  67. Parmley WW, Glick G, Sonnenblick EH (1968) Car-diovascular effects of glucagon in man. N Engl J Med 279: 12–17

    Article  PubMed  CAS  Google Scholar 

  68. Parrillo JE, Burch C, Shelhamer JH et al. (1985) A circulating myocardial depressant substance in humans with septic shock. J Clin Invest 76: 1539–1553

    Article  PubMed  CAS  Google Scholar 

  69. Pert CB (1979) Opiate receptors and their natural peptide ligands. In: Bunney WE Jr, moderator. Basic and clinical studies of endorphins. Ann Intern Med 91: 239–250

    Google Scholar 

  70. Pert CB, Synder SH (1973) Opiate receptor: demonstration in nervous tissue. Science 179: 1011–1014

    Article  PubMed  CAS  Google Scholar 

  71. Prough DS, DeWitt DS (1988) Cerebral protection. In: Chernow B (ed) The pharmacologic approach to the critically ill patient. Williams & Wilkins, Baltimore, pp 198–218

    Google Scholar 

  72. Reid JL, Wing LMH, Mathias CJ et al. (1977) The central hypotensive effect of clonidine. Studies in tetraplegic subjects. Clin Pharmacol Ther 21: 375–381

    Google Scholar 

  73. Ruffolo RR, Jr (1988) Cardiovascular adrenoceptors: physiology and critical care implications. In: Chernow B (ed) The pharmacologic approach to the critically ill patient. Williams & Wilkins, Baltimore, pp 166–183

    Google Scholar 

  74. Runciman WB, Skowronski GA (1984) Pathophysiology of haemorrhagic shock. Anaesth Intensive Care 12: 193–205

    PubMed  CAS  Google Scholar 

  75. Sayeed MM (1986) Alterations in cellular Ca regulation in the liver in endotoxic shock. Am J Physiol 250:R884- R891

    Google Scholar 

  76. Shalaby MR, Aggarwal BB, Rinderknecht E et al. (1985) Activation of polymorphonuclear neutrophil functions by interferon-gamma and tumor necrosis factor. J Immunol 135: 2069–2073

    PubMed  CAS  Google Scholar 

  77. Siegel JH (1987) Physiologic and metabolic correlations in human septic shock. In: First Vienna shock forum, Part A: pathophysiological role of mediators and mediator inhibitors in shock. Liss, New York, pp 439–457

    Google Scholar 

  78. Siegel JH, Vary TC (1987) Sepsis, abnormal metabolic control and the multiple organ failure syndrome. In: Siegel JH (ed) Trauma: emergency surgery and critical care. Churchill Livingstone, Edinburgh, pp 411–502

    Google Scholar 

  79. Siegel JH, Greenspan M, Del Guercio LRM (1967) Abnormal vascular tone, defective oxygen transport and myocardial failure in human septic shock. Ann Surg 165: 504–517

    Article  PubMed  CAS  Google Scholar 

  80. Smith EF III, Lefer AM, Nicolaou KC (1981) Mechanism of coronary vasoconstriction induced by carbocyclic thromboxane A2. Am J Physiol 240: H493 - H497

    PubMed  CAS  Google Scholar 

  81. Spitzer JA, Deaciuc IV (1986) Effect of endotoxicosis and sepsis on intracellular calcium homeostasis in rat liver. Mitochondrial and microsomal calcium uptake. Circ Shock 18: 81–93

    Google Scholar 

  82. Spitzer JA, Deaciuc IV (1987) IP3-dependent Ca2+ release in permeabilized hepatocytes of endotoxemic and septic rats. Am J Physiol 253: E130 - E134

    PubMed  CAS  Google Scholar 

  83. Stanford GG, Boyd III JL, Chernow B (1988) Middle messenger systems and their alterations in sepsis and multiple organ failure. In: Cerra F, Bihari DJ (eds) New horizons: perspectives in multiple organ failure. Society of Critical Care Medicine, Fullerton, California (in press)

    Google Scholar 

  84. Stenmark KR, James SL, Voelkel NF et al. (1983) Leukotriene C4 and D4 in neonates with hypoxemia and pulmonary hypertension. N Engl J Med 309: 77–80

    Article  PubMed  CAS  Google Scholar 

  85. Tracey KJ, Beutler B, Lowry SF et al. (1986) Shock and tissue injury induced by recombinant human cachectin. Science 234: 470–474

    Article  PubMed  CAS  Google Scholar 

  86. Unger RH, Orci L (1981) Glucagon and the A cell. N Engl J Med 304:1518–1524, 1575–1580

    Google Scholar 

  87. Vary TC, Siegel JH, Nakatani T et al. (1986) Regulation of glucose metabolism by altered pyruvate dehydrogenase. J Parenter Enteral Nutr 10: 351–355

    Article  CAS  Google Scholar 

  88. Wagensteen OH (1972) In: Thal AP, Brown EB, Hermreck AS, Bell HH (eds) Shock - a physiologic basis for treatment. Year Book Medical Publishers, Chicago, pp 5–8

    Google Scholar 

  89. Zaloga GP, Chernow B, Zajtchuk R et al. (1984a) Diagnostic dosages of protirelin ( TRH) elevate BP by noncatecholamine mechanisms. Arch Intern Med 144: 1149–1152

    Google Scholar 

  90. Zaloga GP, Hostinsky C, Chernow B (1984b) Endogenous opioid peptides: Critical care implications. Heart Lung 13: 421–430

    Google Scholar 

  91. Zimmerman JJ, Dietrich, KA (1987) Current perspectives on septic shock. Pediatr Clin North Am 34: 131–163

    PubMed  CAS  Google Scholar 

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Authors
  1. J. L. Boyd
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  2. G. G. Stanford
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  3. B. Chernow
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Editor information

Editors and Affiliations

  1. University of London, London WC1, UK

    Jack Tinker BSc, FRCP, FRCS, DIC (Dean of Postgraduate Medicine, Honorary Consultant Physician) (Dean of Postgraduate Medicine, Honorary Consultant Physician)

  2. The Middlesex Hospital, London W1, UK

    Jack Tinker BSc, FRCP, FRCS, DIC (Dean of Postgraduate Medicine, Honorary Consultant Physician) (Dean of Postgraduate Medicine, Honorary Consultant Physician)

  3. Harvard Medical School and Massachusetts General Hospital, 02114, Boston, Massachusetts, USA

    Warren M. Zapol MD (Professor of Anaesthesia) (Professor of Anaesthesia)

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© 1992 Springer-Verlag London Limited

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Boyd, J.L., Stanford, G.G., Chernow, B. (1992). The Pathophysiology of Shock. In: Tinker, J., Zapol, W.M. (eds) Care of the Critically Ill Patient. Springer, London. https://doi.org/10.1007/978-1-4471-3400-8_17

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  • DOI: https://doi.org/10.1007/978-1-4471-3400-8_17

  • Publisher Name: Springer, London

  • Print ISBN: 978-1-4471-3402-2

  • Online ISBN: 978-1-4471-3400-8

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