Septic Shock Questions & Answers

Updated: Jan 11, 2019
  • Author: Andre Kalil, MD, MPH; Chief Editor: Michael R Pinsky, MD, CM, Dr(HC), FCCP, FAPS, MCCM  more...
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Questions & Answers

Overview

What is sepsis and when does septic shock occur?

What are the signs and symptoms of sepsis?

Which signs and symptoms of sepsis can be localized to organ systems?

How is sepsis/septic shock diagnosed?

Which lab studies are indicated in the workup of sepsis/septic shock?

Which other studies are indicated in the workup of sepsis/septic shock?

What is the initial treatment of sepsis/septic shock?

What are the treatment goals of sepsis/septic shock?

What are the management principles for sepsis/septic shock?

Which medications are used in the management of septic shock?

When is surgery indicated in sepsis/septic shock?

What is the difference between sepsis and septicemia?

How does sepsis affect organ systems and when is septic shock present?

What are the classes of circulatory shock?

What are the causes and signs of hypovolemic shock?

What causes obstructive shock?

What are the causes and signs of distributive shock?

What are the features of cardiogenic shock?

What is the criteria for sepsis and how is it diagnosed?

What is systemic inflammatory response syndrome (SIRS) in sepsis/septic shock?

What are the clinical criteria for systemic inflammatory response syndrome (SIRS) in sepsis/septic shock?

How were the definitions of sepsis syndromes established?

How is sepsis defined and what is sepsis-induced organ dysfunction?

What is septic shock?

What is bacteremia and how is it associated with sepsis?

What is multiple organ dysfunction syndrome (MODS) in sepsis/septic shock?

What are the classifications of acute respiratory distress syndrome (ARDS) in sepsis/septic shock?

How does multiple organ dysfunction syndrome (MODS) develop and progress in sepsis/septic shock?

Why is oxygen uptake limited in sepsis/septic shock?

What are the risk factors for severe sepsis and septic shock?

What is the pathophysiology of septic shock?

Which inflammatory mediators are involved in the pathogenesis of sepsis?

Which receptors are involved in the initiation of sepsis response in sepsis/septic shock?

What is the role of cytokines in the pathophysiology of sepsis?

What is the role of bacteria in the pathophysiology of sepsis/septic shock?

How does hypotension occur in sepsis/septic shock?

What is the role of active nitrogen molecules in the progression of sepsis/septic shock?

What is the role of mitochondrial dysfunction in sepsis/septic shock?

What is the role of neutrophils in sepsis/septic shock?

How does sepsis-induced immunosuppression affect the prognosis of sepsis/septic shock?

What is the role of coagulation and fibrinolysis abnormalities in the pathophysiology of sepsis/septic shock?

What is the role of circulatory abnormalities in sepsis/septic shock?

What is the main hemodynamic feature of septic shock?

What is the role of peripheral arterial vascular tone in the pathophysiology of sepsis/septic shock?

Which factors contribute to myocardial depression in sepsis/septic shock?

What causes peripheral blood flow abnormalities in sepsis/septic shock?

What causes low oxygen extraction in sepsis/septic shock?

What are the mechanisms of cell injury and resulting organ dysfunction in sepsis/septic shock?

What is the pathophysiology of cardiovascular dysfunction in sepsis/septic shock?

What is the pathogenesis of sepsis-induced ARDS in sepsis/septic shock?

What is the pathophysiology of acute lung injury (ALI)/mild ARDS in sepsis/septic shock?

How does acute lung injury (ALI) progress in sepsis/septic shock?

What is the pathophysiology of acute respiratory distress syndrome (ARDS) and what are the phases of ARDS in sepsis/septic shock?

What are the features of the exudative phase of diffuse alveolar damage (DAD) in sepsis/septic shock?

What are the features of the proliferative phase of diffuse alveolar damage (DAD) in sepsis/septic shock?

What are the features of the fibrotic phase of diffuse alveolar damage (DAD) in sepsis/septic shock?

What is the role of the GI tract in the pathophysiology of sepsis/septic shock?

What is the role of the liver in the pathophysiology of sepsis/septic shock?

What is the role of sepsis/septic shock in acute kidney injury (AKI)?

What is the role of the central nervous system (CNS) in the pathophysiology of sepsis/septic shock?

Who is most at risk for developing sepsis/septic shock?

Which diseases most commonly predispose to sepsis?

Is the source of infection related to sepsis or septic shock always identifiable?

Are gram-positive or gram-negative bacteria more likely to cause sepsis/septic shock?

Which types of infections most commonly cause sepsis/septic shock?

How often do lower respiratory tract infections cause septic shock and what are the common pathogens?

How often do abdominal and GI tract infections cause septic shock and what are the common pathogens?

How often do urinary tract infections cause septic shock and what are the common pathogens?

How often do reproductive system infections cause septic shock and what are the common pathogens?

How often do soft-tissue infections cause septic shock and what are the common pathogens?

How often do infections due to foreign bodies cause septic shock and what are the common pathogens?

Which infections are rarely associated with septic shock and what is a common cause of these infections?

Why has the incidence of sepsis in the US been increasing in recent years?

What is the incidence of sepsis in the US?

What are the age-related demographics of sepsis and septic shock?

What are the sex-related demographics of sepsis and septic shock?

What are the race-related demographics of sepsis and septic shock?

What are the mortality rates associated with sepsis and septic shock?

Which clinical characteristics are associated with the severity of sepsis and mortality?

Which risk factors are associated with increased mortality rates in sepsis and septic shock?

What are the long-term effects of sepsis/septic shock?

Presentation

What are the symptoms of sepsis/septic shock?

What are the features of fever in sepsis/septic shock?

How is mental impairment characterized in sepsis/septic shock?

Is hyperventilation associated with sepsis/septic shock?

Which symptoms of sepsis are associated with specific organ systems?

Can the signs of sepsis and septic shock be observed in a physical exam?

How is a physical exam for sepsis conducted?

What does purpura look like in disseminated intravascular coagulation (DIC) associated with sepsis/septic shock?

How do tachycardia and tachypnea manifest in sepsis/septic shock?

What does an altered mental status indicate in sepsis/septic shock?

Which physical signs can localize the source of infection in sepsis/septic shock?

What are the most severe complications of sepsis/septic shock?

What is the incidence of acute respiratory distress syndrome (ARDS) in sepsis/septic shock and what are the potential outcomes?

What is the incidence of acute kidney injury (AKI) in sepsis/septic shock?

What are possible complications of sepsis/septic shock other than ARDS and AKI?

DDX

What are the degrees of severity of sepsis?

What should be considered in the early diagnosis of sepsis/septic shock?

How should a patient with sepsis or septic shock be monitored in the ICU?

What are the differential diagnoses for Septic Shock?

Workup

What are the approach considerations in the workup for sepsis or septic shock?

How is a CBC count with differential used in the workup of sepsis/septic shock and which findings indicate bacterial infection?

How is a hemoglobin concentration used in the workup of sepsis/septic shock?

What do platelet levels indicate in the workup of sepsis/septic shock?

How is coagulation status assessed in the workup of sepsis/septic shock?

How is metabolic assessment used in the workup of sepsis/septic shock?

What is the role of glucose control in the management of sepsis/septic shock?

What is the role of serum lactate in the workup of sepsis/septic shock?

Which lactate levels are associated with increased mortality in sepsis/septic shock?

Which chemistry studies are used to assess renal and hepatic function in the workup of sepsis/septic shock?

How are liver function tests (LFTs) used in the workup of sepsis/septic shock?

What cortisol level is diagnostic of septic shock in patients suspected of having adrenal insufficiency?

Are free cortisol measurements useful in the workup of sepsis/septic shock?

When are blood cultures indicated in the workup of sepsis/septic shock?

Which patients are at risk for bacteremia and sepsis/septic shock?

What are the recommendations for blood cultures in the workup of sepsis/septic shock?

How can recovery of aerobic bacteria be optimized in suspected intra-abdominal infection associated with sepsis/septic shock?

Which organisms should be tested for in blood cultures in the workup of sepsis/septic shock?

When are urinalysis and urine culture indicated in the workup of sepsis/septic shock?

When is a Gram stain indicated in the workup of sepsis/septic shock?

How is a Gram stain and culture used in the workup of sepsis/septic shock?

When are routine culture and susceptibility studies indicated in the workup of sepsis/septic shock?

What is the role of Gram staining in the workup of sepsis/septic shock?

When is chest radiography indicated in the workup of sepsis/septic shock?

How is ARDS associated with sepsis/septic shock characterized on chest radiography?

Which abdominal views are indicated in the workup of sepsis/septic shock and when should they be obtained?

When is plain radiography of the extremities indicated in the workup of sepsis/septic shock?

When is immediate surgical consultation indicated in the workup of sepsis/septic shock?

How is osteomyelitis evaluated in the workup of sepsis/septic shock?

When is abdominal ultrasonography indicated in the workup of sepsis/septic shock?

How is echocardiography used in the assessment of sepsis/septic shock?

What is the imaging modality of choice to exclude an intra-abdominal abscess or a retroperitoneal source of infection in the workup of sepsis/septic shock?

When is abdominal CT scanning indicated in the workup of sepsis/septic shock?

Which imaging study is useful in the workup of deep soft tissue infection associated with sepsis/septic shock?

When is head CT scanning indicated in the workup of sepsis/septic shock?

Which procedure is indicated when bacterial meningitis is suspected in a patient with sepsis/septic shock?

When is lumbar puncture indicated in the workup of sepsis/septic shock and how should the procedure be performed?

Treatment

When is admission to a general hospital ward indicated in sepsis/septic shock?

When is admission to an ICU indicated in sepsis/septic shock?

Is early goal-directed therapy (EGDT) effective in the management of severe sepsis/septic shock?

What are the goals and management principles for the treatment of sepsis/septic shock?

How is adequate venous access achieved in the treatment of sepsis/septic shock?

How is urinary catheterization used in the treatment of sepsis/septic shock?

How is intubation and mechanical ventilation used in the treatment of sepsis/septic shock?

What are the priorities of resuscitation in septic shock?

What are the treatment guidelines for sepsis/septic shock?

What should be completed within 3 hours of sepsis/septic shock resuscitation?

What should be completed within 6 hours of sepsis/septic shock resuscitation?

What are the guidelines for managing pregnant women with sepsis/septic shock?

What is the role of measuring effective oxygen delivery and organ blood flow in the treatment for sepsis/septic shock?

What does respiratory support consist of in the treatment of sepsis/septic shock?

How is central venous pressure measured in sepsis/septic shock and how is a crystalloid fluid challenge used in treatment?

How is urinary output monitored in sepsis/septic shock?

Is colloid solution beneficial in the treatment of sepsis/septic shock?

Which fluids are recommended for circulatory support in sepsis/septic shock?

How are anemia and coagulopathy corrected in sepsis/septic shock?

What is the role of antibiotic therapy in the treatment of sepsis/septic shock?

What is the role of temperature control in the treatment of sepsis/septic shock?

What metabolic and nutritional support is recommended in the treatment of sepsis/septic shock?

What is septic shock and what are the goals of hemodynamic therapy?

How is tissue perfusion evaluated in septic shock and what are the signs of inadequate perfusion?

How is hemodynamic support accomplished in septic shock?

What is the role of fluid resuscitation in the treatment of sepsis/septic shock?

How is hemodynamic improvement defined, measured, and achieved in sepsis/septic shock?

Is pulmonary edema more likely with crystalloid solutions or colloid solutions?

What is the latest research on early goal-directed therapy for sepsis/septic shock?

When is vasopressor therapy indicated in sepsis/septic shock?

What is the goal of vasopressor therapy in sepsis/septic shock?

What is the recommended first-line vasopressor for sepsis/septic shock?

How is dopamine used for vasopressor therapy in sepsis/septic shock?

Which second-line agents are available for vasopressor therapy in sepsis/septic shock and when are they indicated?

How is norepinephrine used in the treatment of sepsis/septic shock?

How is synthetic human angiotensin II used in the treatment of sepsis/septic shock?

How is dopamine used in the treatment of sepsis/septic shock?

When is epinephrine used in the treatment of sepsis/septic shock?

What is the role of phenylephrine in the treatment of sepsis/septic shock?

How does vasopressin work in the treatment of sepsis/septic shock?

What is the role of inotropic therapy in sepsis/septic shock?

How is tissue hypoxia detected and corrected in sepsis/septic shock?

What is the role of dobutamine in the treatment of sepsis/septic shock?

How does oxygen delivery to tissue aid in treatment of sepsis/septic shock?

When should empiric antimicrobial therapy be initiated in sepsis/septic shock and what are the guidelines for administration?

When is combination empiric therapy indicated in the treatment of sepsis/septic shock and for how long?

What are the considerations when using antimicrobial therapy in the treatment of sepsis/septic shock?

Which antibiotics are used in the treatment of sepsis/septic shock?

What are the newest FDA-approved antibiotics used in the treatment of sepsis/septic shock?

What are the guidelines for antibiotic therapy for non-ICU patients with pneumonia and sepsis/septic shock?

What are the guidelines for antibiotic therapy for ICU patients with pneumonia and sepsis/septic shock?

What are the guidelines for treating influenza A and H5N1 infection in sepsis/septic shock?

Which antibiotic therapies are effective in the treatment of intra-abdominal infections in sepsis/septic shock?

Which antibiotics are not recommended for treatment of intra-abdominal infections in sepsis/septic shock?

How is corticosteroid therapy used in the treatment of sepsis/septic shock?

When is high-dose corticosteroid therapy indicated in the treatment of sepsis/septic shock?

What study data is available on the use of corticosteroid therapy to treat sepsis/septic shock?

What are the guidelines for corticosteroid therapy in the treatment of sepsis/septic shock?

What is the target glucose level in sepsis/septic shock?

What are the guidelines for DVT prophylaxis in severe septic shock?

What is the treatment for disseminated intravascular coagulation (DIC) in septic shock?

What are the guidelines for plasma and platelet transfusion for the treatment of DIC in sepsis/septic shock?

When is heparin indicated in the treatment of DIC in sepsis/septic shock?

When is antifibrinolytic therapy indicated in the treatment of DIC in sepsis/septic shock?

What are the risks and prognosis of ARDS in sepsis/septic shock?

How is ARDS managed in sepsis/septic shock?

What are the goals of mechanical ventilation in sepsis/septic shock?

How effective is mechanical ventilation at improving survival rates in ARDS in sepsis/septic shock?

How does the use of positive end-expiratory pressure (PEEP) affect ventilator-induced lung injury in sepsis/septic shock?

How are corticosteroids used in the treatment of ARDS in sepsis/septic shock?

When is surgery indicated in sepsis/septic shock?

What causes impaired host defense mechanisms which increase the risk of sepsis/septic shock?

How does the use of ventilatory support and invasive catheters affect the risk factors of sepsis/septic shock?

How can antibiotics mitigate the risk of sepsis/septic shock?

How is progression from infection to sepsis/septic shock reversed?

Medications

What are the most important aspects of medical therapy in the treatment of sepsis/septic shock?

Which medications in the drug class Corticosteroids are used in the treatment of Septic Shock?

Which medications in the drug class Antibiotics are used in the treatment of Septic Shock?

Which medications in the drug class Volume Expanders are used in the treatment of Septic Shock?

Which medications in the drug class Isotonic crystalloids are used in the treatment of Septic Shock?

Which medications in the drug class Vasopressors are used in the treatment of Septic Shock?