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At least 19 recordsLinked to original sources
PubMed1978

A new model for the study of septic shock.

Septic shock was produced in 28 healthy mongrel dogs by injecting 10(8) Escherichia coli organisms per kilogram into the gallbladder following division of the cystic artery and duct. Based upon the circulatory responses and the mortality, two distinct groups emerged. In one, the cardiac index decreased significantly, and the total peripheral resistance was elevated. In the other, the cardiac index increased significantly, and the total peripheral resistance was significantly lower. The average survival time in the former group was three days and, in the latter, five days. The physiopathology of this model is remarkably similar to that of human septic shock. Studies are planned to further describe this model to increase its utility in the study of septic shock.

Animals↗
PubMed1979

Comparative haemodynamic effects of dopamine and dobutamine in septic shock.

Septic shock associated with depressed myocardial function generally requires the use of catecholamine. Currently dopamine is often selected. Dobutamine is a newly developed catecholamine which has been shown to be of value in severe cardiomyopathic disease. The aim of this work was to determine the most appropriate drug by comparing haemodynamic responses to dopamine and dobutamine in 19 studies carried out in 11 patients with septic shock and heart failure. Cardiac index increased siliarly with dopamine and dobutamine (33%), as did stroke volume (respectively 26.4 and 25%). Arterial pressure increased by 17% with dopamine whereas it did not significantly change with dobutamine due to reduction in vascular resistance of 19%. Dobutamine decreased filling pressure, either right (14%) of left (28%) whilst they slightly but unsignificantly increased with dopamine. Pulmonary shunting increased more with dopamine (47%) than with dobutamine (16%), but PaO2 remained constant with both. Since septic shock is characterized by lowered arterial pressure and vasodilatation it is concluded that effects of dopamine on capacitance and resistance vessels make this drug more suitable. In addition it selectively increases renal blood flow. Nevertheless dobutamine could be appropriate, in case of very high filling pressures, severe peripheral vasoconstriction, marked pulmonary shunting and in some cases where dopamine becomes ineffective.

Catecholamines↗
PubMed2026

Plasma proteomic profiling of septic shock and acute pancreatitis identifies shared signatures and disease-specific pathways.

Septic shock represents the most severe form of infection-driven systemic inflammation, whereas acute pancreatitis induces a sterile inflammatory response. Although clinically similar, their molecular profiles may reveal distinct mechanisms underlying infectious and non-infectious inflammation. We performed plasma proteomic profiling using LC-MS/MS in patients with septic shock (n = 13), acute pancreatitis (n = 8), and healthy controls (n = 8). Among 663 quantified proteins, 231 were differentially expressed in septic shock versus controls, 83 in pancreatitis versus controls, and 29 in septic shock versus pancreatitis. Septic shock was characterized by higher plasma concentrations of MARCKS, HSP90AA1, PSAP, CD163, and GANAB, whereas pancreatitis showed higher levels of CPA1, APOC4, APOC3, BPGM, and APOC2. Cluster analysis demonstrated separation between groups, with overlapping proteomic patterns in sepsis and pancreatitis. Gene Ontology and KEGG analyses revealed shared inflammatory signatures, including upregulation of acute-phase responses and downregulation of coagulation pathways. However, septic shock exhibited more extensive proteomic alterations, with distinct activation of PI3K-Akt signaling and suppression of lipid metabolism. In conclusion, septic shock and pancreatitis share common inflammatory pathways, while proteomic differences highlight divergent regulation of coagulation, lipid metabolism, and anti-inflammatory signaling, offering potential biomarkers to distinguish infectious from sterile systemic inflammation.

Shock, Septic↗
PubMed1979

The effect of septic shock on skeletal muscle action potentials in the primate.

Techniques developed for the in vivo study of cellular physiology have been applied to septic shock in primates. Measurements of skeletal muscle transmembrane resting and action potentials were correlated with an analysis of fluid and electrolyte changes in the intracellular and extracellular compartments of skeletal muscle. The data obtained indicated a marked depletion of muscle extracellular water and an increase in intracellular sodium chloride and water content during shock. The significant decrease of resting membrane potential was associated with a decrease in amplitude of the action potential and prolongation of both the repolarization and depolarization time. In addition, there was a decrease of muscle intracellular potassium concentration during shock. This study demonstrates that the alterations in cellular membranes in hemorrhagic shock and septic shock are similar.

Action Potentials↗
PubMed1978

Prospective study of the treatment of septic shock.

A study of 113 patients with septic shock admitted to an intensive therapy unit (I.T.U.) during a 3-year period showed that a significant reduction in mortality was achieved after the introduction of a treatment programme which included early intermittent positive-pressure ventilation and aggressive surgery in addition to conventional management with fluids, oxygen, and antibiotics. Vasoactive drugs played an important but not essential role in therapy.

Adult↗
PubMed1979

[Septic shock].

It has become necessary to review septic shock in the light of recent experimental work, as well as the clinical implementation of this knowledge. Emphasis is laid on the surgical aspects of management of patients with this condition.

Anti-Bacterial Agents↗
PubMed1979

Septic shock in pediatrics.

A review of the septic shock syndrome in pediatrics, analyzing its actual incidence in clinical practice, etiopathological factors, physiopathology, clinical manifestations in the different stages of the disease, diagnostic criteria, prognostic, and treatment is presented.

Acute Kidney Injury↗
PubMed2025

Inflammatory pathways and immune dysregulation in pediatric postoperative septic shock: A study integrating transcriptomics, machine learning and molecular docking.

This study elucidates the molecular and immune regulatory mechanisms of pediatric postoperative septic shock. Transcriptomic data were obtained from the Gene Expression Omnibus database. Differentially expressed genes were identified using the limma package, and gene co-expression modules were constructed using Weighted Gene Co-expression Network Analysis. Functional enrichment was performed via gene set enrichment analysis, Gene Ontology, and Kyoto Encyclopedia of Genes and Genomes analyses. Immune cell infiltration was assessed using ESTIMATE and CIBERSORT. Mendelian randomization was applied to explore causal relationships between gene expression and septic shock. Feature genes were selected using machine learning algorithms, and a diagnostic nomogram model was constructed. Finally, molecular docking analysis was performed to screen and evaluate the binding affinity of traditional Chinese medicine monomers to core target proteins. A total of 1331 differentially expressed genes were identified, and the turquoise module was strongly correlated with septic shock. Enrichment analysis revealed significant activation of IL-6/JAK/STAT3, TNF-α/NF-κB, and PI3K/Akt/mTOR pathways. Immune infiltration analysis indicated suppressed immune scores and imbalances in neutrophils, macrophages, T cells, and B cells. Mendelian randomization confirmed causal associations for 6 genes, including PIM3. The predictive model based on feature genes demonstrated high diagnostic performance. Molecular docking suggested that quercetin and astramembrannin I could stably bind PIM3. This study systematically identified core genes, dysregulated immune pathways, and candidate small-molecule interventions in pediatric septic shock, providing novel insights for early diagnosis and targeted therapy.

Humans↗
PubMed1979

Reversal by calcium of rat heart cell dysfunction induced by human sera in septic shock.

Twenty human sera obtained during the first 24 hours following clinical onset of different septic shocks were evaluated for their effects on electric an mechanical activities of rat heart cell cultures. Possible antagonistic action of calcium was tested on these effects. The results showed that septic shock sera, when compared to normal sera, increased action potential duration and depressed contractility of beating cardiac cells. Addition of calcium reversed these two actions, though markedly higher concentration was needed for depressed contractility. The in vitro deleterious effects of septic shock sera on cell cultures were related neither to decrease in extracellular calcium, since total calcium level was moderately below normal values, nor to inhibition of low calcium channel, since the action potential was not suppressed in presence of K+ excess. This study suggests the involvement of humoral factors mimicking the cardiac effects of low calcium concentration. If calcium is involved in in vitro cardiac dysfunction, it could result only from a decrease of available calcium in cytosol.

Action Potentials↗
PubMed2026

The effect of dexmedetomidine in mechanically ventilated patients with sepsis and septic shock: a meta-analysis of randomized controlled trials.

PURPOSE: Dexmedetomidine (DEX) is a central sympatholytic with sedative properties widely used in critically ill patients. However, its effects in patients with sepsis and septic shock remain controversial. This meta-analysis evaluated the efficacy and safety of DEX compared to other sedatives in mechanically ventilated patients with sepsis and septic shock. METHODS: A systematic search was conducted across PubMed, Embase, Scopus, and Cochrane Library from inception through May 1, 2025 for randomized controlled trials comparing DEX with other sedatives or placebo in mechanically ventilated patients with sepsis and septic shock. Primary outcomes included overall mortality and Sequential Organ Failure Assessment (SOFA) scores. Secondary outcomes encompassed duration of mechanical ventilation (MV), length of stay in Intensive Care Unit (ICU), incidence of hypotension and bradycardia. RESULTS: Fifteen studies involving 3,882 patients (1,945 in the DEX group, 1,937 in the control group) were included. DEX was demonstrated no significant differences compared to other sedatives or placebo in overall mortality (Risk Ratio [RR] 0.98, 95% Confidence Interval [CI] 0.90 to 1.07, p = 0.71, I2 = 0%), SOFA scores (Mean Difference [MD] - 0.14, 95% CI -0.81 to 0.52, p = 0.67, I2 = 0%), length of stay in ICU (MD -0.32, 95% CI -1.69 to 1.06, p = 0.65, I2 = 77%), or incidence of hypotension (RR 1.15, 95% CI 0.81 to 1.62, p = 0.44, I2 = 14%). However, DEX significantly reduced the duration of MV (MD -0.54, 95% CI -0.98 to -0.10, p = 0.02, I2 = 25%) but was associated with an increased incidence of bradycardia (RR 1.67, 95% CI 1.22 to 2.28, p = 0.001, I2 = 0%). CONCLUSIONS: In mechanically ventilated patients with sepsis and septic shock, DEX shortened duration of MV but was associated increased bradycardia risk. No mortality or organ dysfunction benefits were observed. These findings suggest DEX is a reasonable therapeutic option to facilitate earlier ventilator weaning in selected patients (particularly those without shock), but careful monitoring for cardiovascular adverse effects is warranted.

Humans↗
PubMed1979

The pony as a model for septic shock.

This study was conducted to determine the feasibility of using alert, conscious ponies as a model for septic shock in man. Ten ponies were given 0.7-5 X 10(9) organisms/kg of body weight of live E coli intravenously over one hour. All ponies died and exhibited signs of low cardiac output septic shock. significant decreases were found in cardiac index to 3.15 +/- 0.1 liters/min/m2 (P less than 0.05), white blood cell count to 1,930 +/- 100 cells/m3 (P less than 0.05), preterminal blood glucose to 75 +/- 5 mg/dl (P less than 0.05), PaO2 to 75.7 +/- 5.7 mm Hg (P less than 0.05), and pH to 7.15 +/- 0.5 (P less than 0.05). Increases were noted in systemic resistance to 3,869 +/- 322 dynes/dic/cm-5 (P less than 0.05), pulmonary resistance to 770.8 +/- 11.12 dynes/sec/cm-5 (P less than 0.05), pulmonary arterial pressure to 41 +/- 7 mm Hg (P less than 0.05), pulmonary wedge pressure to 19.5 +/- 2.5 mm Hg (P less than 0.05), intrapulmonary shunt to 16.43 +/- l.73% (P less than 0.05), early blood glucose to 204 +/- 9.0 mg/dl (P less than 0.05), and excess lactate concentration to 53.06 +/- 5.3 mg/dl (P less than 0.05). From these data it appears that the septic pony shows changes similar to low output septic shock documented in man.

Animals↗
PubMed2026

Balanced Fluid or 0.9% Saline in Children Treated for Septic Shock.

BACKGROUND: Whether treatment with balanced crystalloid fluid leads to better outcomes than 0.9% saline in children treated for septic shock is debated. METHODS: In this pragmatic clinical trial conducted at 47 emergency departments in five countries, patients (2 months to <18 years of age) with suspected septic shock and abnormal perfusion were randomly assigned to receive fluid resuscitation with either balanced fluid or 0.9% saline for up to 48 hours. The primary outcome was a major adverse kidney event (a composite of death, new renal-replacement therapy, or persistent kidney dysfunction) at 30 days after enrollment or hospital discharge, whichever occurred first. RESULTS: Of 9041 enrolled patients, 277 (6.1%) in the balanced-fluid group and 282 (6.2%) in the 0.9%-saline group withdrew from the trial, leaving 4235 and 4247 patients, respectively, for analysis. A primary-outcome event occurred in 137 patients (3.4%) in the balanced-fluid group and in 124 (3.0%) in the 0.9%-saline group (difference, 0.4 percentage points; 95% confidence interval [CI], -0.5 to 1.3; risk ratio, 1.10; 95% CI, 0.88 to 1.40; P&#x2009;=&#x2009;0.85). The median number of hospital-free days during 28 days after enrollment was 23 (interquartile range, 19 to 25) in both groups. Hyperchloremia occurred in 868 patients (31.4%) in the balanced-fluid group and in 1383 (49.0%) in the 0.9%-saline group; hypernatremia in 52 (1.8%) and 89 (3.1%), respectively; and hyperlactatemia in 260 (19.8%) and 228 (16.7%). No differences in other safety outcomes or adverse events were seen. CONCLUSIONS: Among children treated for septic shock, no significant difference was seen in the incidence of death, new renal-replacement therapy, or persistent kidney dysfunction when fluid resuscitation was administered with balanced fluid as compared with 0.9% saline. (Funded by Eunice Kennedy Shriver National Institute of Child Health and Human Development and others; PRoMPT BOLUS ClinicalTrials.gov number, NCT04102371.).

Adolescent↗
PubMed1977

Histamine and sympathetic blockade in septic shock.

The relative roles of endogenously released histamine and the sympathetic nervous system in septic shock were indirectly studied by blocking each one separately. Antihistamines in doses of 3-10 mg/kg prevented severe blood pressure drops and improved urinary output in groups treated before and after shock. Release of histamine seems to be important at least in the pathogenesis of early septic shock, although analysis of blood pressure pattern and survival implicates additional factors in late shock. Epidural block in combination with E. coli injection was detrimental, producing severe hypotension and even immediate death. Neural sympathetic tone is essential to survival in shock.

Anesthesia, Epidural↗
PubMed1978

[Comparative study of the effects of dobutamine and dopamine in septic shock].

This work aims at the evaluation of the effects of dobutamine in the effects of dobutamine in the treatment of septic shock and to compare them to the effects of dopamine used in the same conditions. Eleven patients presenting with both a state of septic shock and confirmed cardiac insufficiency were submitted to the protocol. The dosage was determined by the clinical results : 6.22 microgram/kg/min for dopamine and 4.2 to 25 microgram/kg/min for dobutamine. The results show that although the effect on cardiac output is comparable with the two drugs, some differences in their effects delineates their respective distinct indications. Indeed, although dobutamine seems less arythmic, lovers more the ventricular filling pressure and increases less the intra-pulmonary shunt, dopamine causes less reduction in the systemic resistance which in the case of septic shock seems more logical. Nevertheless dobutamine is perhaps easier to handle.

Blood Pressure↗
PubMed2025

Vasoactive Agent Therapy in Septic Shock: From Monotherapy Battles to Tailored Hemodynamic Optimization.

Hemodynamic stabilization and preservation of organ perfusion are central elements in the management of septic shock. This is achieved by fluid resuscitation and by administration of vasoactive agents to secure a time window for definitive cause-directed therapy. Guided by the Surviving Sepsis Campaign, the optimization of vasoactive agent strategies, namely protective hemodynamic management, has become a central focus. Tracing key research over the past 25 years reveals a paradigm shift in vasopressor therapy, from empiricism to goal-directed strategy. This evolution has deepened our understanding of the benefit-risk profile of vasoactive agents and fostered a new conceptual framework regarding organ perfusion and protection. Under this framework, management strategies have advanced from the mere pursuit of hemodynamic parameters to care bundles that integrate the monitoring of organ perfusion, microcirculation, and oxygen metabolism. These advances have optimized agent selection, established safe dosing ranges, and ultimately promoted the widespread adoption of combined and multimodal therapy concepts. This review delineates this transformative journey, synthesizing evidence on the reappraisal of traditional agents and exploring "de-catecholaminization" strategies, thereby aiming to broaden the therapeutic landscape. The integration of artificial intelligence and genomic medicine is expected to further advance personalized management strategies for septic shock.

Humans↗
PubMed1979

Methyldopa reaction simulating septic shock.

Though drug fever from methyldopa is well known, to my knowledge fever and hypotension simulating septic shock have never been described in this country as a syndrome resulting from methyldopa therapy. Three such cases are presented here, all proved on rechallenge. They erroneously accounted for almost 6% of all cases of septic shock at St Elizabeth Medical Center in the last ten years.

Aged↗
PubMed1978

Ionized calcium and magnesium: the effect of septic shock in the baboon.

Ionized calcium (Ca2+) and ionized magnesium (Mg2+) are important intracellular "second messengers" and control exictation-contraction coupling, excitation-secretion, oxidative phosphorylation, and mitochondrial acid-base balance. The present study examines the effect of septic shock on serum (Ca2+) and (Mg2+). Five adult female baboons were subjected to live E. coli septic shock and then resuscitated. Three baboons served as controls. Ca2+ was measured by the Orion SS-20 flow-through calcium electrode and Mg2+ calculated by the method of Killen. Other measurements included: total calcium, bound calcium, total magnesium, bound magnesium, phosphate, albumin, globulin, hemotocrit, and total protein. This study shows that there are significant disturbances of Ca2+ and Mg2+ during septic shock in the baboon. These disturbances may in part explain cellular dysfunction during shock including: decreased myocardial contractility, inappropriate secretion of endocrine cells, decrease in oxidative phosphorylation, and mitochondrial acidosis.

Animals↗