Shock is a life-threatening condition that occurs due to a mismatch in the supply and consumption of oxygen, which leads to cell and tissue hypoxia, resulting in cell death and dysfunction of vital organs. The effects of shock are reversible in the early stages, but delay in diagnosis and initiation of treatment can lead to irreversible changes. There are four main categories of shock: hypovolemic, distributive, cardiogenic, and obstructive. The aim of the paper is to present a new perception of viewing the etiopathogenesis and effectively establish the diagnosis of shock. Hypovolemic shock can occur due to hemorrhagic and non-hemorrhagic causes. Distributive shock is divided into septic, systemic inflammatory response syndrome (SIRS), anaphylactic, neurogenic, and endocrine. Cardiogenic shock occurs due to intracardiac causes, while obstructive shock occurs due to extracardiac causes. The pathogenesis of each type of shock is different depending on the etiology. Generally speaking, shock has three phases: compensated, cellular distress phase, and decompensated. When the shock progresses into an irreversible phase, it usually ends with multiorgan failure (MODS) and death. Symptoms may vary depending on the type and stage of shock. The most important changes during this syndrome are at the level of hemodynamics, so the most common clinical signs are hypotension, tachycardia, tachypnea, disturbed mental status, cold extremities, and oliguria. The diagnosis of shock is based on history, clinical presentation, physical examination, vital parameters and biochemical analyses, SOFA criteria (sequential organ failure assessment score), acid-base status, diuresis measurement, etc. Understanding the etiopathogenesis of shock and recognizing its early signs are vital for timely interventions that lead to improved patient outcomes.
References
1.
Lier H, Bernhard M, Hossfeld B. Hypovolämisch-hämorrhagischer Schock. Der Anaesthesist. 2018;67(3):225–44.
2.
Slaughter AL, Nunns GR, D’Alessandro A, Banerjee A, Hansen KC, Moore EE, et al. The Metabolopathy of Tissue Injury, Hemorrhagic Shock, and Resuscitation in a Rat Model. Shock. 2018;49(5):580–90.
3.
Bloom JE, Chan W, Kaye DM, Stub D. State of Shock: Contemporary Vasopressor and Inotrope Use in Cardiogenic Shock. Journal of the American Heart Association. 2023;12(15).
4.
Cusack R, Leone M, Rodriguez AH, Martin-Loeches I. Endothelial Damage and the Microcirculation in Critical Illness. Biomedicines. 10(12):3150.
5.
Martin L, Koczera P, Zechendorf E, Schuerholz T. The Endothelial Glycocalyx: New Diagnostic and Therapeutic Approaches in Sepsis. BioMed Research International. 2016;2016:1–8.
6.
Jeschke MG, van Baar ME, Choudhry MA, Chung KK, Gibran NS, Logsetty S. Burn injury. Nature Reviews Disease Primers. 6(1).
7.
Kim TS, Choi DH. Liver Dysfunction in Sepsis. The Korean Journal of Gastroenterology. 2020;75(4):182–7.
8.
Chang JC. Thrombogenesis and thrombotic disorders based on ‘two-path unifying theory of hemostasis.’ Blood Coagulation & Fibrinolysis. 2018;29(7):585–95.
9.
Gill A, Ackermann K, Hughes C, Lam V, Li L. Does lactate enhance the prognostic accuracy of the quick Sequential Organ Failure Assessment for adult patients with sepsis? A systematic review. BMJ Open. 2022;12(10):e060455.
10.
Singer M, Deutschman CS, Seymour CW, Shankar-Hari M, Annane D, Bauer M, et al. The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA. 2016;315(8):801.
11.
Deitch EA, Condon M, Feketeova E, Machiedo GW, Mason L, Vinluan GM, et al. Trauma-Hemorrhagic Shock Induces a CD36-Dependent RBC Endothelial-Adhesive Phenotype. Critical Care Medicine. 2014;42(3):e200–10.
12.
American College of Chest Physicians/Society of Critical Care Medicine Consensus Conference. Critical Care Medicine. 1992;20(6):864–74.
13.
Gotts JE, Matthay MA. Sepsis: pathophysiology and clinical management. BMJ. :i1585.
14.
Shankar-Hari M, Phillips GS, Levy ML, Seymour CW, Liu VX, Deutschman CS, et al. Developing a New Definition and Assessing New Clinical Criteria for Septic Shock. JAMA. 2016;315(8):775.
15.
Muraro A, Worm M, Alviani C, Cardona V, DunnGalvin A, Garvey LH, et al. EAACI guidelines: Anaphylaxis (2021 update). Allergy. 2022;77(2):357–77.
16.
Moreno R, Rhodes A, Singer M, Vincent JL. Real-world inter-observer variability of the sequential organ failure assessment (SOFA) score in intensive care medicine: the time has come for an update: authors’ reply. Critical Care. 27(1).
17.
Song J, Park DW, Moon S, Cho HJ, Park JH, Seok H, et al. Diagnostic and prognostic value of interleukin-6, pentraxin 3, and procalcitonin levels among sepsis and septic shock patients: a prospective controlled study according to the Sepsis-3 definitions. BMC Infectious Diseases. 2019;19(1).
18.
Mauriello A, Marrazzo G, Del Vecchio GE, Ascrizzi A, Roma AS, Correra A, et al. Echocardiography in Cardiac Arrest: Incremental Diagnostic and Prognostic Role during Resuscitation Care. Diagnostics. 14(18):2107.
19.
Zantonelli G, Cozzi D, Bindi A, Cavigli E, Moroni C, Luvarà S, et al. Acute Pulmonary Embolism: Prognostic Role of Computed Tomography Pulmonary Angiography (CTPA). Tomography. 8(1):529–39.
Bone RC, Balk RA, Cerra FB, Dellinger RP, Fein AM, Knaus WA, et al. Definitions for Sepsis and Organ Failure and Guidelines for the Use of Innovative Therapies in Sepsis. Chest. 1992;101(6):1644–55.
22.
Weil MH, Shubin H. Proposed Reclassification of Shock States with Special Reference to Distributive Defects. Advances in Experimental Medicine and Biology. 1972. p. 13–23.
23.
Vincent JL, Sakr Y, Sprung CL, Ranieri VM, Reinhart K, Gerlach H, et al. Sepsis in European intensive care units: Results of the SOAP study*. Critical Care Medicine. 2006;34(2):344–53.
24.
Moore EE, Moore FA, Sauaia A. Hemorrhagic shock: basics of resuscitation. J Trauma. 2007;62(6 Suppl).
25.
Vincent JL. International Study of the Prevalence and Outcomes of Infection in Intensive Care Units. JAMA. 2009;302(21):2323.
26.
Angus DC, van der Poll T. Severe Sepsis and Septic Shock. New England Journal of Medicine. 2013;369(9):840–51.
27.
Ring J, Beyer K, Biedermann T. Guideline for acute therapy and management of anaphylaxis. Allergo J Int. 2014;23(3):96–112.
28.
Taylor MP, Wrenn P, O’Donnell AD. Presentation of neurogenic shock within the emergency department. Emergency Medicine Journal. 2017;34(3):157–62.
29.
Circulatory Shock. New England Journal of Medicine. 2014;370(6):582–3.
30.
Palacios Ordonez C, Garan AR. The landscape of cardiogenic shock: epidemiology and current definitions. Current Opinion in Cardiology. 2022;37(3):236–40.
31.
Zotzmann V, Rottmann FA, Müller-Pelzer K, Bode C, Wengenmayer T, Staudacher DL. Obstructive Shock, from Diagnosis to Treatment. Reviews in Cardiovascular Medicine. 23(7).
32.
Shah IK, Merfeld JM, Chun J, Tak T. Pathophysiology and Management of Pulmonary Embolism. International Journal of Angiology. 2022;31(03):143–9.
33.
Hof S, Marcus C, Kuebart A, Schulz J, Truse R, Raupach A, et al. A Toolbox to Investigate the Impact of Impaired Oxygen Delivery in Experimental Disease Models. Frontiers in Medicine. 9.
34.
Furer A, Wessler J, Burkhoff D. Hemodynamics of Cardiogenic Shock. Interventional Cardiology Clinics. 2017;6(3):359–71.
35.
Blumlein D, Griffiths I. Shock: aetiology, pathophysiology and management. British Journal of Nursing. 2022;31(8):422–8.
36.
Wasyluk W, Wasyluk M, Zwolak A. Sepsis as a Pan-Endocrine Illness—Endocrine Disorders in Septic Patients. Journal of Clinical Medicine. 10(10):2075.
37.
Patel S, Holden K, Calvin B, DiSilvio B, Dumont T. Shock. Critical Care Nursing Quarterly. 2022;45(3):225–32.
The statements, opinions and data contained in the journal are solely those of the individual authors and contributors and not of the publisher and the editor(s). We stay neutral with regard to jurisdictional claims in published maps and institutional affiliations.
,
