Hemodynamic and Metabolic Studies on Shock Associated with Bacteremia

Article1 May 1965Hemodynamic and Metabolic Studies on Shock Associated with BacteremiaObservations on 16 PatientsVASANT N. UDHOJI, M.B., B.S., MAX HARRY WEIL, M.D., PH.D., F.A.C.P.VASANT N. UDHOJI, M.B., B.S., MAX HARRY WEIL, M.D., PH.D., F.A.C.P.Author, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-62-5-966 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptAcute hypotension and clinical features of shock may be presenting features in patients who have bacteremia caused by endotoxin-producing gram-negative bacteria. Our present understanding of the hemodynamic abnormalities in this type of shock is incomplete, and current concepts of pathophysiology are largely based on animal studies. The extrapolation of findings in experimental animals to the understanding of bacterial shock in human patients is difficult because of species differences, the artificiality of an experimental model that employs single injections of endotoxins, and the special circumstances of infection and underlying disease in human patients (1, 2).Two years ago, we (3) reported...References1. ZWEIFACH BW: Aspects of comparative physiology of laboratory animals relative to the problem of experimental shock. Fed. Proc. 20: 18, 1961. MedlineGoogle Scholar2. SPINKANDERSON WWD: Experimental studies on the significance of endotoxin in the pathogenesis of brucellosis. J. Clin. Invest. 33: 540, 1954. CrossrefMedlineGoogle Scholar3. UDHOJIWEILSAMBHIROSOFF VNMHMPL: Hemodynamic studies on clinical shock associated with infection. Amer. J. Med. 34: 461, 1963. CrossrefMedlineGoogle Scholar4. WEILSPINK MHWW: The shock syndrome associated with bacteremia due to gram-negative bacilli. Arch. Intern. Med. (Chicago) 101: 184, 1958. CrossrefGoogle Scholar5. SHUBINWEIL HMH: Bacterial shock, a serious complication in urological practice. JAMA 185: 850, 1963. CrossrefMedlineGoogle Scholar6. WEILSHUBIN MHH: Shock caused by gram-negative microorganisms; analysis of 169 cases. Ann. Intern. Med. 60: 384, 1964. LinkGoogle Scholar7. HALLGOLD WHD: Shock associated with bacteremia; review of thirty-five cases. Arch. Intern. Med. (Chicago) 96: 403, 1955. CrossrefGoogle Scholar8. SELDINGER SI: Catheter replacement of the needle in percutaneous arteriography. Acta Radiol. (Stockholm) 39: 368, 1953. CrossrefMedlineGoogle Scholar9. HAMILTONMOOREKINSMANSPURLING WFJWJMRC: Studies on the circulation. IV. Further analysis of the injection method, and of changes in hemodynamics under physiological and pathological conditions. Amer. J. Physiol. 99: 534, 1932. CrossrefGoogle Scholar10. SEVERINGHAUSBRADLEY JWAF: Electrodes for blood pO2 and pCO2 determination. J. Appl. Physiol. 13: 515, 1958. CrossrefMedlineGoogle Scholar11. GREGERSENRAWSON MIRA: Blood volume. Physiol. Rev. 39: 307, 1959. CrossrefMedlineGoogle Scholar12. BARKERSUMMERSON SBWH: The colorimetric determination of lactic acid in biological material. J. Biol. Chem. 138: 535, 1941. CrossrefGoogle Scholar13. FRIEDEMANNHAUGEN TEGE: Pyruvic acid. II. The determination of keto acids in blood and urine. J. Biol. Chem. 147: 415, 1943. CrossrefGoogle Scholar14. BRODERWEIL GMH: Excess lactate: an index of reversibility of shock in human patients. Science 143: 1457 1964. CrossrefMedlineGoogle Scholar15. SHUBINWEIL HMH: Acute elevation of serum transaminase and lactic dehydrogenase during circulatory shock. Amer. J. Cardiol. 11: 327, 1963. CrossrefMedlineGoogle Scholar16. WEILMACLEANVISSCHERSPINK MHLDMBWW: Studies on the circulatory changes in the dog produced by endotoxin from gram-negative microorganisms. J. Clin. Invest. 35: 1191, 1956. CrossrefMedlineGoogle Scholar17. ZAMECNIKNATHANSONAUB PCITJC: Physiologic action of clostridium Welchii (Type A) toxins in dogs. J. Clin. Invest. 26: 394, 1947. CrossrefMedlineGoogle Scholar18. FREEDBERGHAIMOVICIBLUMGART ASHHL: The cardiovascular dynamics in shock due to infection. J. Clin. Invest. 23: 930, 1944. Google Scholar19. GILBERT RP: Mechanisms of the hemodynamic effects of endotoxin. Physiol. Rev. 40: 245, 1960. CrossrefMedlineGoogle Scholar20. MASHFORDMAHONCHALMERS MLWATC: Studies of the cardiovascular system in the hypotension of liver failure. New Eng. J. Med. 267: 1071, 1962. CrossrefMedlineGoogle Scholar21. HECKERSHERLOCK RS: Electrolyte and circulatory changes in terminal liver failure. Lancet 2: 1121, 1956. CrossrefGoogle Scholar22. ABELMANNKOWALSKIMCNEELY WHHJWF: The hemodynamic response to exercise in patients with Laennec's cirrhosis. J. Clin. Invest. 34: 690, 1955. CrossrefMedlineGoogle Scholar23. MURRAYDAWSONSHERLOCK JFAMS: Circulatory changes in chronic liver disease. Amer. J. Med. 24: 358, 1958. CrossrefMedlineGoogle Scholar24. HOLMESLOVITT ROWV: Studies of the portal venous system by injection technique. Gastroenterology 17: 209, 1951. CrossrefMedlineGoogle Scholar25. FRITTSHARDEWIGROCHESTERDURANDCOURNAND HWADFJA: Estimation of pulmonary arteriovenous shunt-flow using intravenous injection of T-1824 dye and Kr85. J. Clin. Invest. 39: 1841, 1960. CrossrefMedlineGoogle Scholar26. RYDELLHOFFBAUER RFW: Multiple pulmonary arteriovenous fistulas in juvenile cirrhosis. Amer. J. Med. 21: 450, 1956. CrossrefMedlineGoogle Scholar27. THOMASBARTTER JPFC: Blood volume measurements in normal subjects and in patients with cirrhosis or cardiac disease. Clin. Sci. 21: 301, 1961. MedlineGoogle Scholar28. EISENBERG S: Blood volume in patients with Laennec's cirrhosis of the liver as determined by radioactive chromium-tagged red cells. Amer. J. Med. 20: 189, 1956. CrossrefMedlineGoogle Scholar29. SHORRZWEIFACHFURCHGOTTBAEZ EBWRFS: Hepatorenal factors in circulatory homeostasis. IV. Tissue origins of the vasotropic principles, VEM and VDM, which appear during evolution of hemorrhagic and tourniquet shock. Circulation 3: 42, 1951. CrossrefMedlineGoogle Scholar30. COHENEDHOLMHOWARTHMCMICHAELSHARPEY-SCHAFER SMOGSJEP: Cardiac output and peripheral bloodflow in arteriovenous aneurysm. Clin. Sci. 7: 35, 1948. MedlineGoogle Scholar31. WARRENELKINNICKERSON JVDCJL: The blood volume in patients with arteriovenous fistulas. J. Clin. Invest. 30: 220, 1951. CrossrefMedlineGoogle Scholar32. SHUBINWEIL HMH: The mechanism of shock following suicidal doses of barbiturates, narcotics, and tranquilizer drugs, with observations on the effects of treatment. Amer. J. Med. In press. Google Scholar33. BARRACLOUGHSHARPEY-SCHAFER MAEP: Hypotension from absent circulatory reflexes. Effects of alcohol barbiturates, psychotherapeutic drugs, and other mechanisms. Lancet 1: 1121, 1963. CrossrefMedlineGoogle Scholar34. WEILMILLER MHBS: Experimental studies on therapy of circulatory failure produced by endotoxin. J. Lab. Clin. Med. 57: 683, 1961. MedlineGoogle Scholar35. HEINEMANNEMIRGILMIJNSSEN HOCJP: Hyperventilation and arterial hypoxemia in cirrhosis of the liver. Amer. J. Med. 28: 239, 1960. CrossrefMedlineGoogle Scholar36. VANAMEEPOPPELLGLICKSMANRANDALLROBERTS PJWASHTKE: Respiratory alkalosis in hepatic coma. Arch. Intern. Med. (Chicago) 97: 762, 1956. CrossrefGoogle Scholar37. ABELMANNKRAMERVERSTRAETENGRAVALLESEMCNEELY WHGEJMMAWF: Cirrhosis of the liver and decreased arterial oxygen saturation. Arch. Intern. Med. (Chicago) 108: 34, 1961. CrossrefMedlineGoogle Scholar38. CONN HO: Spontaneous peritonitis and bacteremia in Laennec's cirrhosis caused by enteric organisms: a relatively common but rarely recognized syndrome. Ann. Intern. Med. 60: 568, 1964. LinkGoogle Scholar39. LILLEHEIMACLEAN RCLD: Physiological approach to successful treatment of endotoxin shock in experimental animal. Arch. Surg. (Chicago) 78: 464, 1959. CrossrefGoogle Scholar40. LONGERBEAMLILLEHEISCOTTROSENBERG JKRCWRJC: Visceral factors in shock. JAMA 181: 878, 1962. CrossrefMedlineGoogle Scholar41. NICKERSON M: Factors of vasoconstriction and vasodilatation in shock. J. Mich. Med. Soc. 54: 45, 1955. MedlineGoogle Scholar42. CORDAYWILLIAMS EJH: Effect of shock and of vasopressor drugs on the regional circulation of the brain, heart, kidney and liver. Amer. J. Med. 29: 228, 1960. CrossrefMedlineGoogle Scholar43. SPINK WW: Endotoxin shock. Ann. Intern. Med. 57: 538, 1962. LinkGoogle Scholar44. LILLEHEILONGERBEAMBLOCK RCJKJH: Physiology and therapy of bacteremic shock: experimental and clinical observations. Amer. J. Cardiol. 12: 599, 1963. CrossrefMedlineGoogle Scholar45. SAMBHIWEILUDHOJI MPMHVN: Acute pharmacodynamic effects of glucocorticoids. Circulation. In press. Google Scholar This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAuthors: VASANT N. UDHOJI, M.B., B.S.; MAX HARRY WEIL, M.D., PH.D., F.A.C.P.Affiliations: Los Angeles, CaliforniaFrom the Shock Research Unit and the Department of Medicine, University of Southern California School of Medicine, and the Los Angeles County Hospital, Los Angeles, Calif.This study was supported by The John A. Hartford Foundation, Inc., New York, and by grants HE-05570 and HE-07811 from the National Heart Institute, U. S. Public Health Service, Bethesda, Md.Requests for reprints should be addressed to Max Harry Weil, M.D., Ph.D., Department of Medicine, University of Southern California School of Medicine, 2025 Zonal Avenue, Los Angeles, Calif. 90033. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited byThe Use of Impedance Cardiography in Predicting Mortality in Emergency Department Patients With Severe Sepsis and Septic ShockMy flow, your flow, flow for all!*Case Report: Escherichia coli Septic Shock Masquerading as ST-Segment Elevation Myocardial InfarctionThe Last 100 Years of SepsisMyocardial dysfunction in the patient with sepsisMyocardial dysfunction in septic shock: Part II. Role of cytokines and nitric oxideMyocardial dysfunction in septic shock: Part I. Clinical manifestation of cardiovascular dysfunctionThe haemodynamics of human septic shock*Septic myocardial depression: No "no" to NO?MYOCARDIAL DYSFUNCTION IN SEPTIC SHOCKClinical Manifestations of Cardiovascular Dysfunction in SepsisCardiovascular Dysfunction in Septic ShockSeptic Shock in Humans Advances in the Understanding of Pathogenesis, Cardiovascular Dysfunction, and TherapyJoseph E. Parrillo, MD, Margaret M. Parker, MD, Charles Natanson, MD, Anthony F. Suffredini, MD, Robert L. Danner, MD, Robert E. Cunnion, MD, Frederick P. Ognibene, MDMyocardial function in septic shockSeptic shock: the cardiovascular abnormality and therapyO2 Transport in Low Flow States of Circulatory Shock and Cardiac ArrestSeptic ShockMyocardial Dysfunction in SepsisCardiovascular Dysfunction in Multisystem Organ Failure: Focus on Septic ShockThe Role of Fluid Replacement in Acute Endotoxin ShockChanging Haemodynamic Concepts in Human Septic ShockInfectious Causes of Acute Cardiac DysfunctionPathophysiologie (Mikrozirkulation und klinisches Bild)Cardiovascular dysfunction in septic shock: new insights into a deadly diseaseThe Relationship Between Oxygen Delivery and Consumption during Fluid Resuscitation of Hypovolemic and Septic ShockSequential Cardiorespiratory Patterns Associated with Outcome in Septic ShockMyocardial FailureSpectrum of cardiovascular function during gram-negative sepsisHypoglycemia as a manifestation of sepsisVenous admixture in human septic shock: comparative effects of blood volume expansion, dopamine infusion and isoproterenol infusion on mismatching of ventilation and pulmonary blood flow in peritonitis.Cardiac output in bacterial shockAlcoholism, infection and altered host defenses: A review of clinical and experimental observationsConsequences of acute renal failure relevant to hepatic failureCardiac Output Determinations in Surgical PatientsBacteræmic ShockShock as a Complication of Sepsis in the Female Genital TractProposed Reclassification of Shock States with Special Reference to Distributive DefectsKlinik und antibiotische Therapie der bakteriellen septischen Erkrankungen in der inneren MedizinEnergy metabolism in surgical patients: Oxygen consumption and blood flowThe Peculiar Hemodynamics of Septic ShockTreatment of Shock Associated with SepsisHypocapnia and gram-negative bacteremic shockChronic lactic acidosis in an adultHigh-Output, Low-Resistance Gram-Negative Septic Shock in ManCirculatory patterns in clinical shockCardiovascular Stresses in SurgeryIsoproterenol for the Treatment of Circulatory ShockMAX HARRY WEIL, M.D., PH.D., F.A.C.P., HERBERT SHUBIN, M.D., F.A.C.P.Shock following acute myocardial infarction current understanding of hemodynamic mechanismsENDOTOXIC SHOCK AND HYPERPYREXIA IN UROLOGICAL PRACTICEAn essay regarding pathogenesis and treatment of shock due to bacteremia with special reference to "gram-negative" shockTHE ROLE OF ANTIBIOTICS, VASOACTIVE DRUGS AND STEROIDS IN GRAM-NEGATIVE BACTEREMIAHämodynamische Veränderungen nach akutem MyokardinfarktHemodynamic and metabolic changes associated with bacterial peritonitisAutomated measurement of cardiac output in patients by use of a digital computerIV. Septic Shock–Pathogenesis and TreatmentIsoproterenol in the Treatment of Shock Due to Bacteremia with Gram-Negative PathogensCurrent status of the shock problem 1 May 1965Volume 62, Issue 5Page: 966-978KeywordsAnimal models of infectionBacteremiaBacterial diseasesCirrhosisHemodynamicsHospital medicineMedical servicesNursesShockTechnicians ePublished: 1 December 2008 Issue Published: 1 May 1965 PDF downloadLoading ...