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Septic Shock

Septic shock is the final, most severe form of sepsis and also the most difficult to treat. Patients in septic shock are often called the “sickest patients in the hospital,” as doctors, nurses, and other healthcare professionals work to save them from long-lasting complications or death.

People are more likely to develop sepsis in the community than in the hospital – up to 87% of cases start from infections people contracted at work, school, or home. Sepsis can start gradually, or the symptoms can come on very suddenly. Sepsis must be treated quickly and efficiently as soon as healthcare providers suspect it. If it isn’t recognized and treated quickly, sepsis can progress to severe sepsis and then to septic shock.

Sepsis is the body’s often deadly response to infection or injury. Like strokes or heart attacks, sepsis is a medical emergency that requires rapid diagnosis and treatment. Sepsis kills and disables millions and requires early suspicion and rapid treatment for survival. Septic shock disproportionately affects certain communities, increasing their disability and mortality rates. Black and Hispanic children are 25% more likely to die from severe sepsis or septic shock than non-Hispanic white children. American Indians and Alaskan Native people in the Indian Health Service area are 1.6 times more likely to die from sepsis than the national average.

Sepsis and septic shock can result from an infection anywhere in the body, such as pneumoniainfluenzaurinary tract infections, or even from a cut on the finger that becomes infected. Worldwide, one-third of people who develop sepsis die. Many who do survive are left with life-changing effects, such as post-traumatic stress disorder (PTSD), chronic pain and fatigue, organ dysfunction (organs don’t work properly), and/or amputations.

When Sepsis Becomes Septic Shock

Sepsis treatment usually requires intravenous (IV) fluids and antibiotics. It is essential that the treatment begin as early as possible. The chance of sepsis progressing to severe sepsis and septic shock, causing death, rises by 4% to 9% for every hour treatment is delayed.

Severe sepsis occurs when one or more of your organs stop working effectively. For example, you could need a ventilator to help you breathe or dialysis to filter toxins from your blood. Any organ can be affected.

People with severe sepsis are already very ill, but if your blood pressure starts to drop, you become even sicker. You go into septic shock. The medical definition of “shock” is a drop or fall in blood pressure. When it is associated with sepsis, it is called septic shock.

 

Sepsis to septic shock

 

Why Septic Shock Is Dangerous

As your heart pumps blood throughout your body, it produces a certain amount of pressure to help push the blood through the blood vessels. The blood then delivers oxygen and nutrients to the organs and other body tissues. It also removes toxins. The average blood pressure for a healthy adult is less than or around 120/80 mmHg. Hypotension, or low blood pressure, occurs when the blood pressure drops to below 90/60. If you are hypotensive, your blood does not have enough force behind it to circulate properly throughout your body. The tissues don’t get the nutrients they need.

Temporary hypotension, caused by dehydration, overheating, even psychological shock can cause dizziness, nausea, and fainting. Usually, those situations resolve when the cause is treated, and the blood pressure and blood flow throughout the body return to normal. But when hypotension is extended, like in septic shock, the prolonged blood pressure drop can cause many complications.

Septic Shock Complications

One of the most serious septic shock complications is organ damage. In some cases, the damage may only be temporary. For example, a person in septic shock may develop acute kidney injury. The kidneys are not able to filter out the toxins from the blood. If this occurs, the patient may need dialysis, a procedure where a machine acts as the body’s kidneys to cleanse the blood. As the body heals, the kidneys may begin functioning again. But in many cases, organ damage is permanent.

Another serious septic shock complication is tissue death (gangrene) that leads to amputations. Not only does hypotension reduce the blood flow to the less vital parts of the body, like the feet and hands, people with severe sepsis or septic shock can develop tiny blood clots in the blood vessels. These clots can block blood that tries to reach the area, resulting in tissue death.

If too much of the tissue has died, a surgeon must remove it to prevent the dead tissue from spreading. Some septic shock survivors must have the tips of fingers and toes removed, while others lose one or both legs, or even all four limbs.

Accurate statistics regarding sepsis-related amputations are not easily available, but a study presented in 2019 looked at 1.5 million sepsis survivors in the United States and the researchers found that one out of every 100 survivors had an amputation within 90 days of their sepsis diagnosis. Most amputations were of the lower limbs.

Septic Shock Treatment

Treating septic shock focuses on increasing the blood pressure, eliminating the infection that triggered the sepsis, and providing support for the organs that are failing. Some treatments could include:

  • IV fluids to raise blood pressure.
  • Medications, including antimicrobials (antibiotics, antivirals), drugs to increase blood pressure, pain relievers, and any other medications to treat immediate issues.
  • Oxygen, either by mask or nasal cannula, or with a ventilator, to help raise oxygen levels in the blood.
  • Surgery, which may be necessary to remove the source of infection, such as gallstones or an inflamed appendix.

Once the blood pressure is back up to normal levels and it stays there, the patient is no longer in septic shock. The patient is still very ill, but no longer with a too-low blood pressure.

After Septic Shock

Most often, you can be discharged from the ICU once your blood pressure is stable and supportive treatment, like a ventilator or dialysis, are no longer required. You will still be monitored and cared for, but in a lower-acuity ward or unit.

Recovering from septic shock can take longer than you may expect. Survivors may appear to be better, but many live with long-lasting effects from having been so ill. Up to 50% of sepsis survivors live with post-sepsis syndrome (PSS), which can be mild or severe. Signs of PSS can include:

  • Insomnia
  • Chronic pain
  • Chronic fatigue
  • Hair loss
  • Memory issues
  • Frequent infections

About one-third of sepsis survivors return to the hospital within three months of their discharge. The most common causes are repeat infection or sepsis. You can learn more from the Life After Sepsis fact sheet.

If you or someone you know shows any signs of sepsis, this is a medical emergency and you must seek medical help immediately to reduce the risk of septic shock.

 

August 11, 2021