Running Head: SEPTIC SHOCK

Analysis Of Therapeutic Management Of Septic Shock

 Running Head: SEPTIC SHOCK

Introduction

Septic shock is a condition characterized by a dangerous fall in blood pressure due to

infections. Septic shock is caused by low immune responses to infections, leading to tissue and

organ injuries and death(Esposito et al., 2017). Septic shock is a serious leading cause of

mortality and morbidity in surgical, medical, and obstetric health conditions. The rate of

mortality is high in patients with septic shock despite the availability of necessary therapy for the

disease. Septic shock can be caused by any microbes; the pathophysiology of the illness is

unknown; and the diagnostic symptom is not precise. There are also no credible laboratory

outcomes of detecting septic shock at an early stage of occurrence (Schneider & Muleta, 2003).

Septic shock leads to circulatory system failure due to inadequacy of tissue perfusion

(Seymour & Rosengart, 2015). Clinical manifestations of septic shock include hypotension (low

systolic ≤90 mm Hg), low arterial blood pressure (≤65 mm Hg), and hypoperfusion signs

(Seymour & Rosengart, 2015)

 Running Head: SEPTIC SHOCK

Therapeutic Management Of Septic Shock

In medical organizations, the management of septic shock poses many challenges to

caregivers since it is associated with increased mortality rates due to organ dysfunction as a

result of a dysregulated host response to infection.

1. Fluid therapy

Fluid therapy involved the administration of fluids and antibiotics to patients affected by

septic shock. This therapy as a form of treatment management is aimed at correcting

hypovolemia through the increment of blood volume and facilitating venous return and cardiac

preload. This increases the level of oxygen delivery in the body of the patient (Rhodes et al.,

2017). Early and effective fluid therapy is important for the stabilization of sepsis-induced tissue

septic shock. Sepsis-induced hypoperfusion can be manifested by acute organ dysfunction and

decreased blood pressure and increased serum lactate.

Since septic shock is seen as an emergency in medical healthcare, septic shock patients are

considered fluid-responsive and treated immediately with a fluid bolus. Fluid administration to

the patient is done at an infusion of 10 mL/kg within half to one hour and with close patient

supervision.

2. Vasopressors therapy

This is the treatment of septic shock-induced hypotension by correcting the vascular tone

depression and improvement of organ perfusion pressure (Shi et al., 2020). The therapy includes

norepinephrine (NE) as the first-line vasopressor in septic shock and Vasopressin second-line
 Running Head: SEPTIC SHOCK

vasopressors. Norepinephrine is considered a first-line vasopressor because it increases blood

pressure through vasoconstrictive properties while not affecting heart rates.

Other vasopressors used in this therapy include Vasopressin, which is recommended as a

second-line vasopressor, Epinephrine is also a second-line vasopressor, and Dopamine.

vasopressors are applied to the patient with septic shock within the first hour when fluid

administration is not low for achieving hemodynamic resuscitation. Administration of

Norepinephrine at an early stage helps in correcting hypotension and then prevention of

prolonged severe hypotension, this is because the duration and extent of hypotension in an early

stage of septic shock determines the outcomes of the patient with the condition (Shi et al., 2020).

Norepinephrine administration in the initial stage increases cardiac output by increasing the

cardiac preload and reduction of preload dependency, this also increases the systemic filling

pressure and blood distribution from unstressed volume to the stressed volume through α-

adrenergic-mediated reduction of venous capacitance. Administration of Norepinephrine plays a

crucial role in exerting of synergistic effect with fluid infusion and improves resuscitation.

Norepinephrine also increases cardiac contractility. Early administration of Norepinephrine is

associated with increased left ventricular ejection fraction, and left and right systolic functions.

3. Monitoring of Patients

For doctors to be able to recognize septic shock in a patient, a physical examination must be

done. Monitoring is essentially used in the determination of a patient’s peripheral oxygen

saturation, urinary output, heart rate, arterial blood pressure, and CVP to obtain information

regarding the hemodynamic status of the patients (Teboul et al., 2016). Patient monitoring is
 Running Head: SEPTIC SHOCK

done with the help of cardiac output measurement tools such as transpulmonary thermodilution

(TPTD). The tool is used to track changes in the blood temperature of patients utilizing femoral

thermistor-tipped arterial catheter thus monitoring cardiac output (CO) in septic shock patients.

Monitoring also employs the use of Echocardiography, a non-invasive monitoring tools for

cardiac output. The tool monitors cardiac output by keeping changes in velocity–time integral

(VTI) of the left ventricular outflow tract.

4. Adjunctive therapy

The therapy involves the use of Steroids, Ascorbic acid, and thiamine. steroids are used

because of adrenal low levels in patients with septic shock (Annane et al., 2002). The steroids

improve cardiovascular functionality by increasing blood volume through mineralocorticoid

activity and enhancing systemic vascular resistance.

5. Antimicrobial therapy

This therapy is done on septic shock patients together with fluid therapy (Peng, 2019). The

therapy involves the collection of aerobics and anaerobic blood culture before the administration

of the antibiotic treatment. Antibiotic administration is done within one hour after septic shock

identification in patients. Antimicrobial therapy helps in determining antimicrobial sensitivity

issues such as the site of infection, the prevalent pathogens, and antimicrobial resistance to the

patient’s age and comorbidities.

Before administration of antibiotics, the caregivers consider the hemodynamic alterations of

septic, this is because of the inadequacy of doses required, increased capillary permeability, the
 Running Head: SEPTIC SHOCK

hyperdynamic state, and excess amount of fluid administered leading to a high volume of

medication distribution(Peng, 2019).

Conclusion

Patients with severe sepsis and/or septic shock are at increased risk of death and organ

dysfunction and display high in-hospital mortality. Since the last SSC guidelines were

issued, a number of studies have provided new information on the pathophysiology and

treatment of septic shock. Despite this growing knowledge, septic shock management

remains a challenging task for the emergency physicians, who have to deal with the initial

detection of the condition and the early phases of treatment. Thus, it is of utmost

importance that emergency physicians be aware of the recent advances on septic patient

management.

In light of the above considerations, this narrative review provides a useful and updated

learning tool that should enable emergency physicians to gather crucial information on

past, present, and future research trajectories of sepsis research.

Overall, we believe that a systematic approach consisting of coordinated detection of

patients with sepsis and early treatment could significantly reduce the mortality of septic

patients in the ED. To further optimize disease management, the emergency physician

should administer treatment taking into account the patients’ characteristics

 Running Head: SEPTIC SHOCK

References

Annane, D., Sébille, V., Charpentier, C., Bollaert, P.-E., François, B., Korach, J.-M., Capellier,
G., Cohen, Y., Azoulay, E., & Troché, G. (2002). Effect of treatment with low doses of
hydrocortisone and fludrocortisone on mortality in patients with septic shock. Jama,
288(7), 862-871.

Esposito, S., De Simone, G., Boccia, G., De Caro, F., & Pagliano, P. (2017). Sepsis and septic
shock: New definitions, new diagnostic and therapeutic approaches. Journal of Global
Antimicrobial Resistance, 10, 204-212.
https://doi.org/https://doi.org/10.1016/j.jgar.2017.06.013

Peng, Z.-Y. (2019). Message from" The Surviving Sepsis Campaign Bundle: 2018 Update".
Journal of Medical Postgraduates, 18-20.

Rhodes, A., Evans, L. E., Alhazzani, W., Levy, M. M., Antonelli, M., Ferrer, R., Kumar, A.,
Sevransky, J. E., Sprung, C. L., Nunnally, M. E., Rochwerg, B., Rubenfeld, G. D.,
Angus, D. C., Annane, D., Beale, R. J., Bellinghan, G. J., Bernard, G. R., Chiche, J. D.,
Coopersmith, C., . . . Dellinger, R. P. (2017). Surviving Sepsis Campaign: International
Guidelines for Management of Sepsis and Septic Shock: 2016. Crit Care Med, 45(3),
486-552. https://doi.org/10.1097/ccm.0000000000002255

Schneider, J., & Muleta, M. (2003). Septic shock. Ethiop Med J, 41(1), 89-104.

Seymour, C. W., & Rosengart, M. R. (2015). Septic Shock: Advances in Diagnosis and
Treatment. Jama, 314(7), 708-717. https://doi.org/10.1001/jama.2015.7885
 Running Head: SEPTIC SHOCK

Shi, R., Hamzaoui, O., De Vita, N., Monnet, X., & Teboul, J. L. (2020). Vasopressors in septic
shock: which, when, and how much? Ann Transl Med, 8(12), 794.
https://doi.org/10.21037/atm.2020.04.24

Teboul, J.-L., Saugel, B., Cecconi, M., De Backer, D., Hofer, C. K., Monnet, X., Perel, A.,
Pinsky, M. R., Reuter, D. A., & Rhodes, A. (2016). Less invasive hemodynamic
monitoring in critically ill patients. Intensive care medicine, 42(9), 1350-1359.