Septic shock

Septic shock is a subset of sepsis in which underlying circulatory, cellular, and metabolic abnormalities are associated with a greater risk of mortality than sepsis alone.

The clinical criteria to identify adult patients with septic shock after adequate fluid resuscitation are:

1. Hypotension requiring vasopressor therapy to maintain mean BP 65 mmHg or greater, and
2. A serum lactate level greater than 2 mmol/L 

The uncomplicated pregnant patient rarely experiences sepsis-related shock; however, it is still a major cause of obstetric maternal death, given that mortality in this group of patients is so uncommon.

Diagnosis

Septic shock is classified into three relatively distinct clinical phases:

1. Early or warm shock
2. Late or cold shock
3. Secondary or irreversible shock.

The clinical and haemodynamic symptoms for each phase are given in the table below:

Septic shock phases table

Stage	Clinical	Haemodynamic
Early	Warm skin, flushing Temperature instability Tachypnoea Altered mental status	Decreased peripheral resistance Peripheral vasodilation Hypotension Increased cardiac output
Late	Cool, clammy skin Oliguria Cyanosis Adult respiratory distress syndrome	Peripheral vasoconstiction Decreased cardiac output Increased peripheral resistance
Secondary	Obtundation Anuria Hypoglycaemia Disseminated intravascular coagulation Myocardial failure	Peripheral vasodilation Decreased cardiac output Decreased peripheral resistance