Skip to main content
SpringerLink
Log in

The haemodynamics of septic shock

  • Published:
Intensive Care Medicine Aims and scope Submit manuscript

Abstract

Both peripheral vascular abnormalities and changes in myocardial function are hallmarks of septic shock. Their complex interactions result in inadequate and maldistributed microcirculatory flow and progressive organ dysfunction. Inappropriate vasodilation, microembolization and endothelial cell injury are proposed mechanisms that may induce maldistribution of flow in the microcirculation and inefficient, defective peripheral oxygen extraction. Abnormal myocardial function is manifested by diminished right and left ventricular ejection fractions, ventricular dilatation, altered Frank-Starling curves and diastolic pressure-volume relationships. These changes are already observed in an early stage of septic shock and are entirely reversible in survivors.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Winslow EJ, Loeb HS, Rahinstoola SH, Kamath S, Gunnar SM (1973) Hemodynamic studies and results of therapy in 50 patients with bacteremic shock. Am J Med 54:421–432

    Google Scholar 

  2. Wiles JB, Cerra FB, Siegel JH, Border JR (1980) The systemic septic response: does the organism matter? Crit Care Med 8:55–60

    Google Scholar 

  3. Parker MM, Parrillo JE (1983) Septic shock. Hemodynamics and pathogenesis. J Am Med Ass 250:3324–3327

    Google Scholar 

  4. Abraham E, Bland RD, Cobo JC, Shoemaker WC (1984) Sequential cardiorespiratory patterns associated with outcome in septic shock. Chest 85:75–80

    Google Scholar 

  5. Parker MM, Shelhamer JH, Bacharach SL, Green MV, Natanson C, Frederick TM, Damske BA, Parrillo JE (1984) Profound but reversible myocardial depression in patients with septic shock. Ann Int Med 100:483–490

    Google Scholar 

  6. Groeneveld ABJ, Bronsveld W, Thijs LG (1986) Hemodynamic determinants of mortality in human septic shock. Surgery 99:140–152

    Google Scholar 

  7. Parker MM, Shelhamer JH, Natanson C, Alling DW, Parrillo JE (1987) Serial cardiovascular variables in survivors and nonsurvivors of human septic shock: heart rate as an early predictor of prognosis. Crit Care Med 15:923–929

    Google Scholar 

  8. Groeneveld ABJ, Nauta JJP, Thijs LG (1988) Peripheral vascular resistance in septic shock: its relation to outcome. Intensive Care Med 14:141–147

    Google Scholar 

  9. Parker MM, Suffredini AF, Natanson C, Ognibene FP, Shelhamer JH, Parrillo JE (1989) Response of left ventricular function in survivors and nonsurvivors of septic shock. J Crit Care 4:19–25

    Google Scholar 

  10. Groeneveld ABJ, Kester ADM, Nauta JJP, Thijs LG (1987) Relation of arterial blood lactate to oxygen delivery and hemodynamic variables in human shock states. Circ Shock 22:35–53

    Google Scholar 

  11. Cunnion RE, Parrillo JE (1989) Myocardial dysfunction in sepsis; recent insights (editorial). Chest 95:941–945

    Google Scholar 

  12. Thijs LG, Groeneveld ABJ (1988) Peripheral circulation in septic shock. Appl Cardiopulm Pathophysiol 2:203–214

    Google Scholar 

  13. Houtchens BA, Westenkow DR (1984) Oxygen consumption in septic shock: a collective review. Circ Shock 13:361–384

    Google Scholar 

  14. Parrillo JE (1985) Cardiovascular dysfunction in septic shock: new insights into a deadly disease. Int J Cardiol 7:314–321

    Google Scholar 

  15. Cunnion RE, Schaer GL, Parker MM, Natanson C, Parrillo JE (1986) The coronary circulation in human septic shock. Circulation 73:637–644

    Google Scholar 

  16. Dhainaut JF, Huyghebaert MF, Monsallier JF, Lefevre G, Dall'Ava-Santucci J, Brunet F, Villemant D, Carli A, Raichvarg D (1987) Coronary hemodynamics and myocardial metabolism of lactate, free fatty acids, glucose, and ketones in patients with septic shock. Circulation 75:533–541

    Google Scholar 

  17. Dahn MS, Lange P, Lobdell K, Hans B, Jacobs LA, Mitchell RA (1987) Splanchnic and total body oxygen consumption differences in septic and injured patients. Surgery 101:69–80

    Google Scholar 

  18. Finley CA, Duff JH, Holliday RL, Jones D, Marchuk JB (1975) Capillary muscle blood flow in human sepsis. Surgery 78:87–94

    Google Scholar 

  19. Thijs LG, Teule GJJ (1983) Is venous pooling an important factor in shock? In Lewis DH, Haglund U (eds), Shock research. Elsevier, Amsterdam, pp 89–99

    Google Scholar 

  20. Ellman H (1984) Capillary permeability in septic patients. Crit Care Med 12:629–633

    Google Scholar 

  21. Fleck A, Raines G, Hawker F, Trotter J, Wallace PI, Ledingham IMcA, Colman KC (1985) Increased vascular permeability: a major cause of hypalbuminaemia in disease and injury. Lancet i: 781–783

    Google Scholar 

  22. Groeneveld ABJ, Heidendal GAK, Den Hollander W, Nauta JJP, Thijs LG (1987) Noninvasive assessment of regional plasma extravasation in porcine septic shock. J Crit Care 2:245–255

    Google Scholar 

  23. Van Lambalgen AA, Van den Bos GC, Thijs LG (1987) Changes in regional plasma extravasation in rats following endotoxin infusion. Microvasc Res 34:116–132

    Google Scholar 

  24. Kaufman BS, Rackow EC, Falk JL (1984) The relationship between oxygen delivery and consumption during fluid resuscitation of hypovolemic and septic shock. Chest 85:336–340

    Google Scholar 

  25. Haupt MT, Gilbert EM, Carlson RW (1985) Fluid loading increases oxygen consumption in septic patients with lactic acidosis. Am Rev Resp Dis 131:912–916

    Google Scholar 

  26. Gilbert EM, Haupt MT, Mandanas RY, Huaringa AJ, Carlson RW (1986) The effect of fluid loading, blood transfusion, and catecholamine infusion on oxygen delivery and consumption in patients with sepsis. Am Rev Resp Dis 134:873–878

    Google Scholar 

  27. Wolf VG, Cotev S, Perel A, Manny J (1987) Dependence of oxygen consumption on cardiac output in sepsis. Crit Care Med 15:198–203

    Google Scholar 

  28. Astiz ME, Rackow EC, Falk JL, Kaufman BS, Weil MH (1987) Oxygen delivery and consumption in patients with hyperdynamic septic shock. Crit Care Med 15:26–28

    Google Scholar 

  29. Cain SM (1984) Supply dependency of oxygen uptake in ARDS: myth or reality? Am J Med Sci 288:119–124

    Google Scholar 

  30. Bihari D, Smithies M, Gimson A, Tinker J (1987) The effect of vasodilation with prostacyclin on oxygen delivery and uptake in critically ill patients. New Engl J Med 317:397–403

    Google Scholar 

  31. Weisel RD, Vito L, Dennis RC, Valeri CR, Hechtmann HB (1977) Myocardial depression during sepsis. Am J Surg 133:512–521

    Google Scholar 

  32. Ellrodt AG, Riedinger MS, Kimchi A, Berman DS, Maddahi J, Swan HJC, Murata GH (1985) Left ventricular performance in septic shock: reversible segmental and global abnormalities. Am Heart J 110:402–409

    Google Scholar 

  33. Ognibene FP, Parker MM, Natanson C, Shelhamer JH, Parrillo JE (1988) Depressed left ventricular performance. Response to volume infusion in patients with sepsis and septic shock. Chest 93:903–910

    Google Scholar 

  34. Rackow EC, Kaufman BS, Falk JL, Astiz ME, Weil MH (1987) Hemodynamic response to fluid repletion in patients with septic shock: evidence for early depression of cardiac performance. Circ Shock 22:11–22

    Google Scholar 

  35. Schneider AJ, Teule GJJ, Groeneveld ABJ, Nauta JJP, Heidendal GAK, Thijs LG (1988) Biventricular performance during volume loading in patients with early septic shock, with emphasis on the right ventricle: a combined hemodynamic and radionuclide study. Am Heart J 116:103–112

    Google Scholar 

  36. Thijs LG, Hack CE, Nuyens JH, Groeneveld ABJ (1989) Peripheral circulation in septic shock. In: Schlag G, Redl H (eds) Second Vienna Shock Forum. Liss, New York, pp 163–174

    Google Scholar 

  37. Raper R, Sibbals WJ, Driedger AA, Gerow K (1989) Relative myocardial depression in normotensive sepsis. J Crit Care 4:9–18

    Google Scholar 

  38. Hoffman MJ, Greenfield LJ, Sugerman HJ, Tatum JL (1983) Unsuspected right ventricular dysfunction in shock and sepsis. Ann Surg 198:307–319

    Google Scholar 

  39. Kimchi A, Ellrodt AG, Berman DS, Riedinger MS, Swan HJC, Murata GM (1984) Right ventricular performance in septic shock: a combined radionuclide and hemodynamic study. J Am Coll Cardiol 4:945–951

    Google Scholar 

  40. Schreuder WO, Schneider AJ, Groeneveld ABJ, Thijs LG (1989) The effect of dopamine versus noradrenaline on hemodynamics in septic shock, with emphasis on right ventricular performance. Chest 95:1281–1288

    Google Scholar 

  41. Sibbald WJ, Paterson NAM, Holliday RL, Anderson RA, Lobb TR, Duff JH (1978) Pulmonary hypertension in sepsis. Measurement by the pulmonary arterial diastolic-pulmonary wedge pressure gradient and the influence of passive and active factors. Chest 73:583–591

    Google Scholar 

  42. Dhainaut JF, Lanore JJ, De Gournay JM, Huyghebaert MF, Brunet F, Villemant D, Monsallier JF (1988) Right ventricular dysfunction in patients with septic shock. Intensive Care Med 14:488–491

    Google Scholar 

  43. Reuse C, Frank N, Contempré B, Vincent JL (1988) Right ventricular function in septic shock. Intensive Care Med 14:486–487

    Google Scholar 

  44. Sibbald WJ, Driedger AA, Myers ML, Short AIK, Wells GA (1983) Biventricular function in the adult respiratory distress syndrome. Hemodynamic and radionuclide assessment, with special emphasis on right ventricular function. Chest 84:126–134

    Google Scholar 

  45. Thijs LG, Groeneveld ABJ, Schneider AJ (1987) Changing hemodynamic concepts in septic shock. In: Kox W, Bihari D (eds) Septic shock and the adult respiratory distress syndrome. Springer, Berlin Heidelberg New York, pp 79–93

    Google Scholar 

  46. Parrillo JE, Burch C, Shelhamer JH, Parker MM, Natanson C, Schuette W (1985) A circulating myocardial depressant substance in humans with septic shock. J Clin Invest 76:1539–1553

    Google Scholar 

  47. Reilly JM, Cunnion RE, Burch C, Whitman C, Parker MM, Shelhamer JH, Parrillo JE (1989) A circulating myocardial depressant substance is associated with cardiac dysfunction and peripheral hypoperfusion (lactic acidemia) in patients with septic shock. Chest 95:1072–1080

    Google Scholar 

  48. Haglund U (1987) Myocardial depressant substances in septic shock. In: Vincent JL, Thijs LG (eds) Septic shock — European view. Springer, Berlin Heidelberg New York, pp 129–138

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Medical Intensive Care Unit, Free University Hospital, De Boelelaan 1117, NL-1081 HV, Amsterdam, The Netherlands

    L. G. Thijs M.D., Ph.D., A. J. Schneider & A. B. J. Groeneveld

Authors
  1. L. G. Thijs M.D., Ph.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. A. J. Schneider
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. A. B. J. Groeneveld
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Thijs, L.G., Schneider, A.J. & Groeneveld, A.B.J. The haemodynamics of septic shock. Intensive Care Med 16 (Suppl 3), S182–S186 (1990). https://doi.org/10.1007/BF01709697

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF01709697

Key Words

Search

Navigation