Any Intensivist who has spent a good amount of time at the bedside (as many academics have not) knows inherently that there are multiple reactions to severe infection or inflammatory disorders that we call “sepsis” and “septic shock”
I’ll name a few but this list is not exhaustive.
GNR Shock with normally working immune system- explosive shock that is secondary to GNR in the blood, from a urinary or abdominal source. Responds relatively quickly to appropriate resuscitation and antibiotics. Pressors bridge the gap. This is classic model sepsis with hyperdynamic LV, high fever, “distributive symptoms” with wide diastolic pressure. Source control is key, but may be the cause - classically presents after cystoscope for a nephrolith when the vascular system is flooded with GNR and builds a response. Very survivable with a good team who knows resuscitation and close attention.
Toxic shock secondary to a Strep - generally GAS- overactive immune system. Requires high dose pressors, fluids, immediate correction of acidosis by any means - mechanical ventilation, crrt, etc. actually some good studies on this.
The dwindles - immunocompromised individuals due to age or disease. Model is a couple things- endocarditis, uti in old or infirm, mild shock in pneumonia. Treatable. Tough to get off pressors. Don’t respond as well to fluids. May not be tachycardic or hyperdynamic. End up on midodtine.
The dwindles plus - same disease process. dwindles + renal or respiratory failure due to poor management earlier in their course. Sicker, higher pressor rqmt
The Cirrhotic special - SBP like shock. Cirrotic vasoplegia. Similar to dwindles but accept a lower MAP target and need more attention to detail, procedures, and the brain bender of albumin and diuretics.
Thank you for reading, Tattered. I appreciated that.
I agree totally with your point and I see the phenotypes you described. There are multiple unknown diseases under the umbrella term "sepsis". However, the researchers are reluctant to acknowledged it. Even when they study phenotypes, they make the fatal mistake of only including patients who satisfy guessed triage criteria like SOFA and qSOFA.
Stay tuned, because so much is coming. We live the calm before the storm.
Excelente. 🙌🏻
Gracias Simón!
I don't think there is a "y" in H pylori!
Thanks David! Fixed.
I love your posts and follow closely.
Any Intensivist who has spent a good amount of time at the bedside (as many academics have not) knows inherently that there are multiple reactions to severe infection or inflammatory disorders that we call “sepsis” and “septic shock”
I’ll name a few but this list is not exhaustive.
GNR Shock with normally working immune system- explosive shock that is secondary to GNR in the blood, from a urinary or abdominal source. Responds relatively quickly to appropriate resuscitation and antibiotics. Pressors bridge the gap. This is classic model sepsis with hyperdynamic LV, high fever, “distributive symptoms” with wide diastolic pressure. Source control is key, but may be the cause - classically presents after cystoscope for a nephrolith when the vascular system is flooded with GNR and builds a response. Very survivable with a good team who knows resuscitation and close attention.
Toxic shock secondary to a Strep - generally GAS- overactive immune system. Requires high dose pressors, fluids, immediate correction of acidosis by any means - mechanical ventilation, crrt, etc. actually some good studies on this.
The dwindles - immunocompromised individuals due to age or disease. Model is a couple things- endocarditis, uti in old or infirm, mild shock in pneumonia. Treatable. Tough to get off pressors. Don’t respond as well to fluids. May not be tachycardic or hyperdynamic. End up on midodtine.
The dwindles plus - same disease process. dwindles + renal or respiratory failure due to poor management earlier in their course. Sicker, higher pressor rqmt
The Cirrhotic special - SBP like shock. Cirrotic vasoplegia. Similar to dwindles but accept a lower MAP target and need more attention to detail, procedures, and the brain bender of albumin and diuretics.
Thank you for reading, Tattered. I appreciated that.
I agree totally with your point and I see the phenotypes you described. There are multiple unknown diseases under the umbrella term "sepsis". However, the researchers are reluctant to acknowledged it. Even when they study phenotypes, they make the fatal mistake of only including patients who satisfy guessed triage criteria like SOFA and qSOFA.
Stay tuned, because so much is coming. We live the calm before the storm.