Specific therapies for septic shock

The initial aim of management is the identification and aggressive treatment of the source of sepsis, and this is combined with supportive measures.

Septic shock differs from other forms of shock, with a high cardiac output and vasodilated peripheries due to maldistribution of the increased blood flow. There is shunting of blood, a lactic acidosis, and capillary leak. If fluid alone does not restore an adequate blood pressure, vasoconstrictors should be used to provide a perfusion pressure to vital organs. As the disease process worsens, the myocardium fails and inotropic support may be required.

Septic shock may be associated with DIC and consumption of platelets. Transfusion of clotting factors and platelets may be required. Newer agents for treating sepsis, including antibacterial endotoxin antibodies, anti-tumor necrosis factor and IL-1 receptor antagonists, and '-NMMA and aminoguanidine which block nitric oxide production, have not proved to be the cure.

Corticosteroids have been tried as a treatment for shock. There is no evidence that they are of value, and in fact they may worsen the condition by contributing to overwhelming infection. The only use for steroids in shock is immediately after spinal cord injury.

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