Clinical review: Circulatory shock--an update: a tribute to Professor Max Harry Weil

Abstract

Circulatory shock is common and associated with high morbidity and mortality. Appropriate shock treatment relies on a good understanding of the pathophysiological mechanisms underlying shock. In this article, we provide an update on the description, classification, and management of shock states built on foundations laid by Dr Max Harry Weil, a key early contributor to this field.

Figure 1

The importance of blood lactate concentrations in determining the presence of shock.

Figure 2

The three 'windows' on shock.

Figure 3

The triangular basis of circulatory shock. The full clinical picture includes the three features of hypotension, altered tissue perfusion and hyperlactatemia, whereas the underlying microcirculatory disturbances are less apparent. However, the systemic presentation is not always complete.

Figure 4

The four types of acute circulatory failure according to Weil and Shubin. Reproduced from [19], with permission.