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Septic Shock

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Management of Dysregulated Immune Response in the Critically Ill

Part of the book series: Lessons from the ICU ((LEICU))

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Abstract

The body’s response to infection consists of the release of various cytokines and mediators inducing a state of vasoplegia clinically characterized by hypotension, increased heart rate, and decreased cardiac output. The hyperdynamic low-pressure state, which we recognizes in clinical practice, is usually the consequence of the initial fluid resuscitation. When hypotension persists and lactate levels are increased, the patient meets the criteria for septic shock, the most severe case of sepsis with still mortality rates of more than 30%. The clinical management of septic shock patients remains a challenge as a limited number of safe and effective treatments together with an even more limited number of parameters to assess adequacy of treatment are present. In addition, almost all available treatments may have significant side effects so that a one-size-fits-all treatment should only be used in the initial start of a treatment schedule. In this chapter, these different elements are discussed and a pledge for personalized treatment of septic shock is made with a physiological base from available experimental and clinical evidence.

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Authors and Affiliations

  1. Department of Pulmonology and Critical Care, NYU School of Medicine, NYU Langone Medical Center, New York, NY, USA

    Jan Bakker

  2. Department of Pulmonology and Critical Care, Columbia University College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, NY, USA

    Jan Bakker

  3. Department of Intensive Care Adults, Erasmus MC University Medical Center, Rotterdam, The Netherlands

    Jan Bakker

  4. Facultad de Medicina, Department of Intensive Care, Pontificia Universidad Católica de Chile, Santiago, Chile

    Jan Bakker

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  1. Department of Anaesthesiology and Intensive Therapy, Semmelweis University, Budapest, Hungary

    Zsolt Molnar

  2. Department of Critical Care, King’s College London, Guy’s & St Thomas’ NHS Foundation Trust, London, UK

    Marlies Ostermann

  3. The Queen’s Medical Research Institute Edinburgh BioQuarter, Centre for Inflammation Research, University of Edinburgh, Edinburgh, UK

    Manu Shankar-Hari

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Bakker, J. (2023). Septic Shock. In: Molnar, Z., Ostermann, M., Shankar-Hari, M. (eds) Management of Dysregulated Immune Response in the Critically Ill. Lessons from the ICU. Springer, Cham. https://doi.org/10.1007/978-3-031-17572-5_6

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