Distributive

Distributive hypotension refers to shock which complicates redistribution of intravascular fluid volume with decreases in arterial vascular tone, dilatation of the venous capacitance vessels, or both (Iabje.,5). The most frequent cause of distributive hypotension is the systemic inflammatory response syndrome-sepsis continuum. Systemic inflammatory response syndrome follows acute insults such as massive reperfusion injury and pancreatitis, while sepsis reflects the same pathophysiology but complicates severe infection. Sepsis is associated with a mortality ranging from 35 to above 50 per cent. Distributive hypotension may also complicate anaphylaxis, neurogenic lesions (traumatic cord injury, spinal anesthesia), and thyroid storm (rare, but acute and life threatening).

Table 5 Distributive causes of hypotension

In sepsis-related distributive hypotension, clinical findings generally include signs of decreased systemic resistance and a hyperdynamic circulatory response (e.g. warm skin, tachycardia, increased pulse pressure, and tachypnea). Both anaphylaxis and anaphylactoid reactions invariably cause flushing and tachycardia, but may also present with symptoms indicating an advanced form of an allergic reaction including urticaria, dyspnea, laryngeal edema, bronchospasm, or abdominal cramps and nausea.

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