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Shock
A Perspective of Septic Shock
Philia Setiawan, MD
Shock Classification
HYPOVOLEMIC
Shock Definition
SHOCK is defined as
a syndrome of impairment of tissue
perfusion and oxygenation
Sepsis, Severe Sepsis, Sepsis induced
hypotension and Septic Shock
(SSC 2012)
Sepsis is defined as the presence (probable or
documented) of infection together with its
manifestation.
Severe sepsis is sepsis with sepsis induced organ
dysfunction and hypoperfusion
Sepsis induced hypotension is defined as SBP <90,
MAP<70 or SBP decrease > 40
Septic shock is defined as sepsis-induced hypotension persisting
despite adequate fluid resuscitation.
Sepsis-induced tissue hypoperfusion is defined as infection-
induced hypotension, elevated lactate, or oliguria.
Pathophysiology of Septic shock
Myocardial
depression
Vasodilata Maldistri
tion bution
Septic
Shock
Ca2+ influx
Cellualar Ca2+
Vasodilatation and
Resistance to vasopressor agent
Maldistribution of Blood Flow
Endotoxins TLR4
C5 Cytokines NO
Myocyte dysfunction
Clinical view of Myocardial depression in Sepsis
Microcirculation :
- BE, Lactate, gastric tonometri (pCO2),
Sublingual pCO2
- OPS : microcirculation blood flow
- T (Core and peripheral temperature difference)
- ScvO2
Mitochondrial dysfunction
Treatment: Supportive and Causal
SSC, 2012
Recent recommendation
Random assigned :
- 0.05-0.2 micro/kgBW/min for 24 hs
- Placebo
Adverse event
Overall Survival
Summary: Treatment for Septic Shock